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The sad truth is that this is due to a variety of problems at a variety of levels. Of course, all that follows is highly dependent on the team, hospital, and location. A the lowest-level, you have doctors who're just assholes. Unfortunately, they don't do a good job at filtering out abrasive personalities upon entry to medical school. In fact, I'd say in some ways they self-select for that type of person. I've worked with heads of departments at huge hospitals who've openly discussed their salaries with me in patient rooms or brushed off a patient's concerns in a condescendingly paternalistic manner only to laugh with colleagues about it the second they step out of the patient's room. I've argued many times with specialists running their own clinic about their exorbitant fees and clever ICD-coding skills -- that some brag about developing -- to squeeze every penny out of insurers, all justified by "we've got to make a living." Assholes in medicine run rampant. Up one level and you have the sheer morbid nature of medicine that physicians deal with on a day-to-day basis. I've given chest compressions to trauma patients with self-inflicted gunshot wounds to the head, and cleaned maggots out of a patient's festering diabetic foot. To the outsider, it is all incredibly shocking and gruesome, but as a physician you grow callous to it. Unfortunately, many times that means growing callous to all emotions and stunting your ability to empathize. Mix that with a superiority complex and you get things like Hispanic Hysteria Syndrome. Go up a level and you've got a huge logistical and resource problem. Hospital physicians, particularly residents at teaching hospitals, are often overloaded with responsibilities and patients. They often feel they cannot give every patient and every obligation full and thorough attention because they are being bombarded by pages for new admissions, calls from other staff, etc. I have seen residents breeze through a list of patients, only giving minimal attention to each, just to avoid being chastised by a superior for not fulfilling all responsibilities in the short time allotted. And when you are severely limited to the number of open beds you have, and you've got a crowded ED, it becomes a game of who can we push out the fastest without killing. At a higher level, you have a hospital who needs to keep the lights on, needs to pay salaries, needs to maximize profits and yet treat patients as best as they can. Unfortunately, many hospitals are being swindled by suppliers who're working through group buying organizations [1], inflating costs and making it difficult for hospitals to hit their margins. There's a lot more I could go on about. |