Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Tuesday, September 05, 2006

People Who Used to be Doctors

Is "doctor" something we are or something we do?

Although attainment of an MD degree forever confers the title of "Doctor", once you decide to make your living doing something else -- even if you use your medical knowledge or background in some way -- you cease to be a "real" doctor.

I'm not talking about our colleagues in research or teaching, but about those who chose careers subsequent to or instead of one in medicine. Careers which don't necessarily need the skills and knowledge of a physician to succeed in, even if an MD does confer an advantage; careers where the majority are in fact not doctors. That is the point at which a doctor is no longer a physician, and more importantly, should not hold himself out as such among his peers -- us.

Michael Crichton graduated from Harvard Medical School, but is now a wonderful writer and successful television and movie producer and director. He used to be a doctor.

Bill Frist also went to Harvard Medical School and practiced for several years as a cardiothoracic surgeon. But since 1995 he has served in the United States Senate as a powerful legislator, and in fact has recently even let his CME lapse. He used to be a doctor.

The lawyer who sued me in the mid-90's had an MD degree as well as a JD. Seven years after my "failure to diagnose" a base-of-tongue cancer in a non-smoker, the patient was alive and well and free of disease; the jury took 15 minutes to find me Not Liable. He used to be a doctor.

Robin Cook, who went to Columbia University Medical School, invented the fiction genre "medical thriller" in 1977. He used to be a doctor (although Flea points out in the comments that Cook never intended to be one.)

William McGuire got an MD from the University of Texas-Austin. He has since used his credentials as a pulmonologist to rake in well over a billion dollars in salary and stock options as the CEO of UnitedHealth Group without having seen a patient in 20 years. He used to be a doctor.

And then there's Joel Fuhrman, who caused such a hubbub over at Pediatric Grand Rounds a while back. He attended the University of Pennsylvania Medical School and is a board-certifed FP in New Jersey, where he specializes in "nutritional medicine." Not Family Practice; not Pediatrics; not Preventive Medicine; "nutritional medicine", an urecognized specialty whose practitioners reject what they were taught in medical school and concentrate on selling non-FDA approved products (products specifically "not intended to diagnose, treat or prevent disease") to their "patients". Fuhrman's major source of income is the books and products he hypes on his website and other media (He has "appeared on hundreds of radio and television shows including: Good Morning America, CNN, Good Day NY, TV Food Network, CNBC, and many more.") So don't waste any more time worrying about him, and whatever he may say, don't feel compelled to accept his views as that of an actual medical colleague. He isn't really a doctor anymore.


At Tue Sep 05, 02:07:00 PM, Blogger Big Lebowski Store said...

I get what you're saying, Dino, but I have a reservation:

Crichton, Cook, Frist, and others, were granted MD's, but they are not practicing medicine. I think we all agree that these guys aren't doctors in the usually understood sense.

Fuhrman is a tougher case. He doesn't practice the medicine he was taught. Here's the catch: Do I practice the medicine I was taught? Sometimes I do, and sometimes I don't. Am I 100% doctor?

How little traditional medicine does one have to practice before it is obvious to all that one is no longer a doctor? Is the answer like the famous description of pornography (i.e. you know it when you see it)?

Back to Frist, suppose he really kept up with his CME's like he was supposed to. Now suppose he did one post-op follow-up per year: Is he a doctor or not? If you say yes, what do you say if he saw one post-op every 6 years? If you say no, how hard would he have to work in order to be called a doctor?

Great post, great food for thought.



At Tue Sep 05, 04:50:00 PM, Blogger #1 Dinosaur said...

Re: Frist: No, he's not a doctor. He's a legislator who used to be a doctor. The CME issue just shows he isn't even trying to fake it anymore. (Yes, I enjoy being incendiary.)

More problematic might be someone working at 2 different careers, ie the "part-time" doctor.

Re: Fuhrman: not only isn't he practicing what he was taught, no one's been taught what he's "practicing", as it's not a recognized specialty. Anyone can write a book, push supplements and do the PR, but what they're doing is sales, not medicine; like Fuhrman.

At Tue Sep 05, 05:56:00 PM, Blogger MedStudentGod (MSG) said...

Are doctors who have their patient's wallets in mind when diagnosing, ordering tests, and the like still a doctor or a businessman? All I know is that when colleagues tell you that the doctor at such and such clinic is more "business oriented than medicine oriented" you'd better be ready to order lots of unnecessary tests. All the while acting like it's OK.

Great post...lots of food for thought.


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