Doctor Hornstein hasn’t gone the way of the dinosaur

Lucy Hornstein is not a curmudgeonly, fat, old Philadelphia native who never wanted to be a doctor but only went to medical school at her parents’ insistence.

In real life I’m not curmudgeonly at all, but I amuse myself by playing at it on the internet.

As for fat, although I’m not skinny by any stretch of the imagination, I did lose fifty-five pounds and have kept most of it off for almost two years now, so I’m gradually removing the three-letter f-word from my list of self-descriptors.

I am not a Philadelphia native. I was born and raised in Washington, DC, which left me with a deep and abiding apathy for all things political. I came to Philadelphia for medical school and discovered that Philly is a black hole. Whenever you get here, especially if you’re born here, no one ever leaves.

Far from going to medical school just for my parents, I wanted to be a doctor from the time I was in third grade. My mother always thought I’d change my mind, but I never did. Both my parents were incredibly supportive of me and all my siblings. All they ever wanted for us was that we should do whatever we wanted, and being a doctor is all I can ever remember wanting to do.

As for old, I’m only in my mid-fifties…oh, crap. I guess I am old.

What don’t they teach you at medical school?

How to be a doctor.

For the first two years they teach you a crap ton of basic information about the human body, its structure and function, what goes wrong with it and things you can do to fix it. Then they set you loose in a hospital for two more years so you can see what all that stuff looks like in real life. Then you graduate and go on to residency training, where you start learning the stuff you need to know to be whatever kind of doctor you’re going to be.

The main thing they teach you in medical school is how to LEARN to be a doctor. That’s why it’s called “practicing”.

You’ve stated that 95% of American medical graduates don’t have what it takes. What sort of people shouldn’t do medicine?

That line about “95% don’t have what it takes” (to do primary care) was a tongue-in-cheek version of the saying about the best defense being a good offense. It worked; lots of people were offended. The idea was to come up with a snappy comeback to all the naysayers in medicine putting down students expressing interest in primary care.

As far as what sort of people shouldn’t do medicine: psychopaths. Other than that, I truly believe it takes all kinds. The best doctor is the one to whom you can best relate. And since there are so many different kinds of people, I think the more different kinds of doctors we have, the better.

There are some basic qualifications: it helps if you’re not stupid. It’s a good idea to not be a jerk. Since you have to delay gratification (as in, living your life) for many years, patience comes in handy. And because of the way medical education is currently funded in this country, it’s not at all a bad idea to start out independently wealthy. You can eventually make it up financially, but there are too many faster, easier, more certain ways to make money than becoming a doctor to make medicine worth your while.

What isn’t true about doctors?

Um, nothing. Everything that is true about pretty much any other group of human beings is also true of “doctors”. Ten percent are gay and fifteen percent are left-handed (same figures as the general population, that is). Some doctors are assholes and some are mensches. Some see patients in offices, some see them in hospitals, and some don’t see them at all. Some love what they do; others, not so much. You can’t really say anything at all about “doctors” as a monolithic group any more than you can say something is true about women, blacks, Jews, Hispanics, or any other population subgroup. Each doctor is unique; just like everyone else.

How shouldn’t you tell someone they are dying?

Like this: “You have six months to live.”

“Oh my God, Doctor; what should I do?”

“My advice is to marry a Jewish woman and move to Buffalo, New York.”

“Why should I do that?”
“It will be the longest six months of your life.”

Seriously, though: Telling someone they are dying is more of a process than an event. Actually, it’s almost impossible to tell someone they’re dying, because even when you say it flat out, no one (and no one in their family) is willing to believe it. So whatever you say and however you say it, you shouldn’t expect the conversation to be short. In fact, it’s usually going to be several conversations, each of which is going to be time-consuming. Bottom line: you need to make sure you have enough time to properly tell someone they are dying.

What shouldn’t a patient go to their doctor about?

Something that’s not there. You wouldn’t believe how often I hear things like: “I was sick last week, but now I’m fine. What did I have?” or “I had a rash right there but it went away. What was it?” How the hell am I supposed to know?? Certainly there are significant medical conditions with symptoms that come and go, but cut me a break, folks. Serious things will declare themselves over time. Most things that go away are not important. Save us all the time and aggravation, and don’t go to the doctor (aside from preventive care, of course) unless there’s something wrong.

You’ve given your blog and book a dinosaur theme in reference to family doctors “going the way of the dinosaur”. Why aren’t there as many family physicians as there used to be?

Progress, finances, and inertia.

Medical advances have resulted in mushrooming specialization that really has produced amazing results in terms of lives saved, prolonged, and otherwise enhanced, which is why the increased number of specialists is perfectly understandable. At the same time, those specialists have hijacked the policy-making arm of medicine, resulting in an increasing disparity between payment for so-called cognitive services (talking to patients, examining them, ordering and interpreting tests to diagnose their ailments) and procedural ones (doing things like surgery). Finally, because medical students are trained in academic settings by definition, they see specialty medicine as the norm. Primary care doctors out in the community are seldom seen as role models to emulate. Students don’t have the chance to see what we do, let alone how incredibly rewarding it is. Thus the entire verkakte ratio of specialty to primary care physicians is self-perpetuating.

What isn’t your book Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor about?

The cover notwithstanding, Declarations of a Dinosaur is not a children’s book about Barney’s funny uncle that Barack Obama would expect to read to his fifth grader if he happened to see it on his desk. It is an informative, snarky treatise on the sorry state of primary care medicine in the United States today. Although originally inspired by the 10 Laws of the Dinosaur on my blog, Musings of a Dinosaur, the book is not a collection of blog posts. It is 239 pages of entirely new material written specifically for aficionados of informative, snarky treatises on the sorry state of primary care medicine in the United States today.

Finally, a hypothetical. If you were diagnosed with a disease tomorrow, what wouldn’t you want it to be?

Any kind of advanced cancer.

My father likes to say, “Live each day as if it’s your last; someday you’ll be right.” I try to live my life so I can answer the second of the following two questions:

1.     If you found out today you had only (whatever limited amount of time) to live, what would you do?

2.     Why aren’t you doing it?

by saying, “I am.”

I know too much about both the natural history of advanced cancer and its treatment, so, like many doctors, I would probably eschew any kind of therapy and just go live out the rest of my life. It’s just that there’s still a lot of stuff I want to do (two novels, at least) so I’m not quite ready to pack it in just yet.

Keep up with Dr Hornstein at Musings of a Dinosaur and have a look at her book:

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What Others Are Saying

  1. janet July 13, 2012 at 2:44 pm

    Thanks so much for turning me on to this doc’s blog! Love it!

    • Max July 13, 2012 at 3:06 pm

      Good to hear Janet!

  2. Thomas Cotterill July 21, 2012 at 9:33 am

    Anti View is the best place to broaden your concept of what constitutes an interesting person.

    • Max July 23, 2012 at 9:27 pm

      Thanks, Thomas.

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  10. valerie davies August 8, 2012 at 5:31 pm

    Great to see someone speaking the truth, particularly about the horrors of cancer treatment.

    • Max August 8, 2012 at 5:37 pm

      It’s interesting just how many doctors there are that say they wouldn’t put themselves through cancer treatment. Thanks for commenting Valerie.

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