Saturday, June 3, 2017

So Many Doctors Are Committing Suicide And This Is Why




Doctors are people, too. Sometimes that means they make mistakes. Sometimes that means you need to cut them a little slack after a hard day. Sometimes that means they just go plain ol' nuts: They attack Uber drivers, become serial killers, and sexually assault women. Y'know, like a bunch of nuts. Pure fringe cases? Maybe. But then why are physicians also twice as likely to kill themselves? What's actually going on here? Cracked sat down with our favorite neurosurgeon, Daniel, and tried to find a polite way to ask: "What's your guys' damage, anyway?"

The Screening Process Is Hilariously Light


Becoming a neurosurgeon is a 15-year process, from undergrad to residency training. Imagine investing that much time only to find out you vigorously suck at your job. It happens, and if you subscribe to the "10,000 hours" theory, it kind of makes sense. Within the government-mandated work-hour restrictions, a new surgeon will only spend about 5,000 to 6,000 hours training over a seven-year period. Mastery is not attainable, so we shoot for competency.

That starts with the screening process. Every medical student finds out their residency on the same day. We call it match day, for obvious reasons (because of how many disappointed students turn to arson). Some specialties aren't very competitive, but neurosurgery sure is. Most years, there are about 170 slots for neurosurgery residents, nationwide. There are four or five hundred applicants. We determine who gets in based on interviews, since we can't actually have them perform brain surgery before they technically know how to do that, fun as it might be.

xmee/iStock"Aw, crap, shouldn't have cut that. Could I get a new aneurysm patient, please?"

Yes, shockingly, selecting a surgeon based on an academic transcript and 15-minute interview is a fallible process. The best we can do is look for glaring red flags, and at least once a year we blackball someone who is clearly crazy. One year, there was a set of identical twins. They each spent the whole interview slamming the other. That is the reddest flag, and neither became neurosurgeons.

Some students try to increase their chances by doing an away-rotation at the hospital of their desired residency. They'll basically spend a month at our hospital trying to impress everybody, usually closing out with a lecture. One year a kid clicked open the wrong folder right before his lecture started and accidentally showed his porn preferences to the audience. We're talking hardcore anal. If he'd been a proctologist, that might have been forgivable...

Bojan89/iStockGuess no one ever told the kid to "Do what you love" on career day.


Here's how Match Day works: On the hiring team, we interview candidates and submit our hiring preferences, and then a mysterious computer algorithm sorts through both those and the applicants' preferences, and jobs get assigned. Both the program and the applicant are then legally obliged to offer and accept the job. You may have noticed there's no time allotted there for a psychological profile, an evaluation of how they will fit into a team, or how they will respond to pressure.

One of my fellow surgery interns scored in the 99th percentile of every standardized test he took. On paper, he was the best surgeon you could possibly imagine. You'd expect him to match to Harvard. Everyone was excited when he matched to our program, because it looked like we might be getting a genius. But the first time we had a patient dying in the trauma bay, he cried for his mommy. I'm being literal, not figurative. He actually cried out for his mom while the rest of us rushed to save a patient.

KatarzynaBialasiewicz/iStockUnless his mom was a) also a brain surgeon, and b) in the next room, that tends to be viewed as a liability.

We wound up firing him three years into his five-year residency. I hope he's out there in some lab curing cancer right now, but I really hope he's not in some ER dealing with actual injured people.

You Have To Literally (And Routinely) Kill To Get Fired


Once the wrong person makes it into a specialty, it's hard to get rid of them. Firing a resident was commonplace in the bygone days of god-like chairmen. Now, firing a resident is difficult, painful, and opens up their program up to lawsuits, because once you've spent a quarter of a million bucks on school, you'll probably fight for your career.

But firing a doctor doesn't just mean the doctor might sue you. Think about all your patients once they learn they were worked on by someone you now deem incompetent to practice medicine. Plus there just aren't many doctors; if we have two residents and fire one of them, there goes half our manpower for the year. Neurosurgery programs aren't like Subway; we can't just put up a "Help Wanted" sign and slap the "Brain Artist" label on the very next applicant.

Jan-Otto/iStock"If you cut this part here they'll die instantly, so try not to. Alright, enough training -- I'm paying you to operate, not learn."



Add all that together, and you wind up with hospitals that'll do anything not to fire a doctor for incompetence. How crazy can that get? I'll let Dallas, Texas answer that question: Back in 2013, one of their neurosurgeons was convicted of crippling four people and killing two more. He did such an aggressively terrible job on dozens more patients that he was charged with aggravated assault. We're talking cutting bone where there was no conceivable reason to, and (according to one bizarre email he sent) intentionally causing paralysis, chronic pain, and even death. Although other doctors complained to the hospital during his campaign of carnage, it took a lawsuit to remove him. And that surgeon trained in very reputable programs. We're talking about a doctor with credentials; not someone who bought a phony degree from Barbados University.

We had a pretty bad surgeon (though not at the horror-movie level) in our city, too. I wound up dealing with him tangentially, when one of his patients came to me for a second opinion. She'd had spine surgery, which included screws in certain parts of her bones to hold them together. She thought her surgery had gone well, because she had a copy of her X-rays after the fact -- and they did look great. But I decided to get another set of X-rays done, just to double-check. And when I got the second set back, it became clear that the X-rays she'd shown me were not her X-rays. He'd done as good a job fixing her spine as that roll of duct tape did in fixing your old Camry's engine block. All I could say was, "Hey look, this is what your X-rays show now. I have no idea how you got those other X-rays but here's what you have to do about it now."

Minerva Studio/iStock"Eh, good enough. The screws are on the inside; she never know ..."

He ended up getting run out of every hospital in town, but it was never a "firing." It was always a "mutual parting." He never lost medical privileges. He eventually moved out of state. While our town rid ourselves of the problem, some other state inherited it. That's not great.

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