My Best Friend Arthur

Published in August, 2006

His name isn’t really Arthur, but he’s a real person. Arthur’s portrait hangs in my office as one of the most prominent framed images on the wall; below that of my family, but above that of my degrees, awards, accolades, and honors.

Arthur and I met during the first days of general surgery residency at Cook County Hospital in Chicago. I had just moved to Chicago from the Northwest and was  a little overwhelmed. Arthur was the resident who always seemed to know better than anybody else what was going on, and had a natural clinical sense that took the rest of us years to acquire.

He was a technical master in the operating room from his first years. His bedside manner was calming, and always reassuring to patients. Arthur became the chief resident in our last year of man’s best surgical residency program, and was esteemed and respected by staff and fellow residents alike. Arthur was a super doctor, who spent 10 years completing training after medical school, with five years of surgery residency, two years of bench research, two years of fellowship and an additional year of subspecialty (pediatric heart surgery) fellowship before he could even start practice. He was the best of the best.

Arthur and I became best friends during our research years. We worked in adjacent rooms in the animal laboratory, and while I was attempting to discover the cure for cancer through the subtleties of human tumor growth in athymic (nude) mice, Arthur was placing bunny hearts in a Langendorf apparatus to determine the mysteries as to why our hearts tick. There were many 0200 night ventures of two young Faustian scientists feverishly attempting to bleed Nature of its secrets. We maintained our sanity with long chats on religion and the meaning of life, shared with our other friend Jack Daniels, drunk out of unused test tubes from our experiments.

I eventually went on to do a fellowship in surgical oncology and Arthur did his fellowship in pediatric heart surgery. Afterwards, Arthur acquired a position at one of the most prestigious pediatric heart centers in the South where he had a thriving practice. However, academics grew wearisome and the desire for private practice grew strong. Arthur had a streak of altruism in his blood and throughout his life he always cared for the underdog, the downtrodden and the unfortunate. His practice in Gulfport, Mississippi was at first modestly lucrative, until declining reimbursements, malpractice crisis issues, overwork exhaustion and declining referral relationships with the cardiologists began to take a toll. He found that by doing a single laser treatment of a varicose vein he could take home more bacon than by performing a high risk medicare CABG and could sleep at night without the worry of an arbitrary lawsuit. Hurricane Katrina totally devastated his home, office and practice. After the big wind, one of the only structures that survived along the coast was a roadside billboard advertising his cosmetic vein surgery center.,

Arthur though about opening up a chain of cosmetic vein centers or doing hair-transplant surgery for alopecia. Both procedures pay better than cardiac surgery. Arthur struggled for many months at coming to terms with his identity. Eventually, he settled into a job working for a hospital in the North on a start-up cardiac surgery team where he is content again. His salary is adequate, the hospital covers his malpractice, and he takes business courses at night with the hope of eventually finding some means of supporting himself and family outside of being a physician.

Arthur’s dilemma typifies the crisis that faces all specialties that are dependent upon hospitals for their practice. These specialties are often associated with exceedingly long work hours which demand major night decisions and weekend call, and include the care of high risk patients that are not only high medical risk but high malpractice risk. These physicians must endure the vagaries and obligations of hospital commitments, which one cannot escape without losing their hospital practice.

Arthur realized that he was a hospital-based physician, wishing to be an office-based doctor removed from hospital obligations. Being caught in Mississippi, a state (like Washington) with low reimbursement and a horrible malpractice crisis, Arthurs’ altruism about caring for the poor and under-served failed to justify the headaches, hassle, absence of appreciation and grief that he had to experience. Arthur desired to do what he did best (pediatric and adult heart surgery), which few (if any) could do as well as he could. His final solution will be to change identities, using business school to offer an alternate means of support for himself and his family.

Our community is witnessing the Doc Arthur phenomenon. As an example, my general surgery practice was approached by various vendors wishing to help us start lasering veins and shifting hairlines around, in the hope of providing a cash-basis service to our patients and thus increase our revenues. These vendors were promptly escorted to the door and given a sound boot. We have seen high quality physicians succumbing to the siren sound of these vendors offering cosmetic services or selling some form of snake oil to their patients. Tricks abound. Some offices have their patients stop by the “potions and elixirs” department on their way out of the door, being cajoled into buying a small, worthless, but very expensive bottle of something, purchased simply because the specialist doctor recommended it.

This is what my chiropractor friends would routinely do, and it is a shame that physicians are doing the same thing. There is actually an ongoing lawsuit in this state related to this type of hucksterism, yet this practice is done because it falls outside of the roving eyes of Medicare and insurance, and thus is directly billable to patients.

It is especially a shame that the environment of medicine now so easily demoralizes physicians. Why is it that so many of us went to medical school, and then competed fiercely to get into seriously demanding residencies, only to find that we are being treated like we aren’t really wanted? Why is it that we have to resort to hucksterism or gimmicks to survive in the medical world? Why is it that the current medical environment quickly becomes repulsive to those that are the brightest and best? What are we going to do about this as a medical society?

If I had a child with a surgical heart problem, I would certainly choose Arthur to operate on the child over anybody else in the world. Yet, we’ve lost Arthur. How many more Arthurs will we lose before we wake up?