I posted this as a response on another blog.  I’ll add it here.

New Doctor: a government-funded population control officer.

Real physicians are disliked because they are feared. They are feared because they claim the capacity to see and understand something, and then react decisively to address it. This is a terrifying quality to the bureaucrat. In their eyes, this is little different than the mugger who robs and stabs a victim. Why are they doing this? Some uncontrollable process going on in their head.

The society that cannot tell a mugger from a doctor is in great danger. Every profession which arrogates the right to decide – schoolteacher, police officer, physician – is being hemmed in and crushed, punished for their audacity.

I saw a patient for the second time, a week after the first. He has AF and bad cardiomyopathy. The Wise decided to anticoagulate him on warfarin. There is a highly sophisticated program for multi-level team monitoring and tracking of his INR, which peaked at 7 and he bled into his leg; he was hospitalized and released; his INR peaked again at 7 but this time without a bleed.

The patient saw me for the first time, and said “Doc, I think they’re trying to fucking kill me!” specifically meaning the medical establishment.
I knew then that I had in my hands a very perceptive and astute person, whose life I would struggle to the utmost to save.

I estimated his risk of embolic stroke and other problems, and his recent two events of “They were trying to fucking kill me!” By discussing the matter with the patient, under informed consent, he competently decided to stop warfarin.

The crowd went wild, and not in a good way. He was unplugged from the Warfarin Process, who carped bitterly and mostly behind my back about taking bad care of the patient. I offered the patient’s documented informed consent; they sneered. I wrote in the chart that the patient equated anticoagulation with “They are trying to fucking kill me!” This inspired much complaint – the language was found to be salacious and rude, unacceptable for the chart. I offered that I was quoting the patient, and I am but a scribe.

The Warfarin Mob retreated, complaining bitterly that the patient was acting AGAINST MEDICAL ADVICE. Should he expire, be hit by a bus, any time over the next year, I am sure that a standards complaint will be filed against my practice technique (and not for the first time.)  He is so sick in many ways, there is no protocol or guideline to follow.  Some of the best ideas in medicine have made him sicker.  There is no guarantee nor refuge in a safe protocol-driven place.  I am like the hunter in the wild.

Medicine, like football, is far more fun to criticize than to perform. That’s why they pay the players so much, but the fans themselves have to pay to attend. The actual playing of football is terrifying and dangerous. It’s so much more rewarding to lick down a few beers and boo the quarterback for throwing an interception.

Medicine’s becoming a spectator sport. I’m one of the dinosaurs who gets down on the field and blocks the defensive lineman, again, and again, and again, etc.
Kudos to the New Doctor! They may wear whites that are pearly white and cost $300 for they will never become dirty, except perhaps at the elbows.

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