Can We Make Medicine More Fun?

Women docs having funThe challenge of how to make the practice of medicine more fun hit me as I was walking from the parking lot to my office with one of my colleagues in internal medicine. He volunteered the observation that our hit-and-run psychiatry consultation service tends to get a high number of requests that are probably inappropriate. Incidentally, we got an apology about one of those recently which validated the impression. I’ve posted about this before, Difficult Psychiatry Consult Questions: Go Ask Alice? – The Practical Psychosomaticist.

My friend admitted that he and other non-psychiatrists frequently ask psychiatric consultants for help on problems they could really manage themselves, including, but not limited to, assessment and management of delirium and conducting decisional capacity assessments.

He also asked me if part of my clinical duties included seeing patients in the outpatient clinic. I told him I didn’t because I’m essentially a psychiatric hospitalist and that I really don’t have time to see outpatients unless there is an emergency. He pointed out that, in addition to covering more than one inpatient medical service, his department also requires him to see clinic patients regularly. Like many of my colleagues, his work ethic is superb–but I wonder if he’s having much fun.

I was dumbfounded at his revelation. I have heard this before from other clinicians in the department of internal medicine. I always wonder why this happens. I suspect part of it is that there are not enough physicians.

This probably occurs everywhere. I saw it for the brief periods of time I was in private practice as well. I read an AMA MorningRounds item which warned about the physician shortage coming. In fact, it’s already here and I fear one of the disincentives for new recruits is the system my friend and I discussed. The shortage of primary care physicians is expected to worsen when the Affordable Care Act (ACA) draws in millions of newly insured Americans. The shortage even now affects 1 in 5 Americans.

Then he told me that he sometimes requests psychiatric consultation when he’s simply overwhelmed with all of his other responsibilities. He knows he probably could manage the issue, but he reaches a point when he is simply overpowered; it’s a threshold effect.

Moreover, his department tells him they’re pleased with his approach and actually encourage it–because it allows for more billing. In some ways it’s all about money.

It became clearer to me then, why it’s so difficult to teach my colleagues outside of psychiatry to handle certain problems more independently. There is no incentive. In fact, there are cultural and systems incentives to do the opposite.

As we parted, he said to me, “Now you understand.” I said that I did. I  respect him a great deal. But I couldn’t help thinking about how to change an organization in order to promote a system that produces a less stressful system that creates an environment which makes it less challenging to achieve genuine patient-centered care and an optimal teaching atmosphere. And to make it fun. We do so much already to move toward that goal.

And I read an interesting below-the-fold article in the June 17th issue of  American Medical News, Serious work put into making primary care fun again – The main point is to free doctors from administrative hassles, which are hindering the evolution of our health care system at every turn. According to the article, “We don’t need more rules or checklists or regulations.”Doc having fun

If we simply accept our system as it is, aren’t we saying to the public and specialty and state boards and the American Board of Medical Specialties (ABMS) that we want empty, wasteful busy work like Maintenance of Certification (MOC) and Maintenance of Licensure (MOL)? How much of over-regulation and interference from so-called “non-profit” boards who make millions from the MOC comes from our own inaction? See Psych Practice: More on MOC, especially the reference to board tax returns about which you can read more, if you can stand it, at Change Board Recertification Board Tax Returns.

And what does that do to our morale and to our drive to change a senseless system? Can we play our way to a more fun culture of medicine?



  1. One of my strategies for dealing with pain in me is trying to joke about myself. When I visit my MD, I try to make her laugh. Won’t work when dealing with patients because many don’t have time for laughs. Often thought MDs should prescribe sitcoms and funny videos as either curative or doing what Marsha Linehan calls improving the moment. That is what most of my 12 Daily Easy Emotional Fitness Exercises try to do. Wish some big pharm would pick up my little program and promote it, but as my mother always said, “If wishes were horses, beggars would fly.”

    Which leads to another of mine and Linehan’s stratgies, She calls it radical acceptance — It is what it is.

    Stay strong, not easy in the health profession, but vital if you want to serve your patients well.


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