Crisis of intra-professional respect bleeds into patient care
Updated: 3 days ago
Kevin Pho: Hi, and welcome to the show where we share the stories of the many who intersect with our healthcare system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Corina Fratila. She is an endocrinologist and she wrote the KevinMD article: Are physicians the stewards of healing that they are meant to be? Corina, welcome to the show. Corina Fratila: Thank you so much, Kevin. It’s good to be here. Kevin Pho: We’ll get into your article in a little bit. But first off, can you share your story and your journey to where you are today? Corina Fratila: I went to medical school in Romania, which is a communist country with a lot of oppression and corruption. I studied hard for six years in medical school. To prepare for the end of the medical school exam, the exam who determines who gets into what residency. It essentially determines the rest of your life as a doctor in Romania. But the system was so corrupt to the point that, the day after the exam, I found out that a lot of my medical school colleagues had access to the exam questions and answers in the day prior to the exam. It ended up being a national scandal and the exam was canceled and all the graduates took the residency exam all over again. But by then, I have lost trust in the system, so I had decided to go learn English and leave my home country. It took me two years to prepare. I went through a neighboring country, Hungary, to take the USMLE exam. Eventually, I moved to New York city. I did my residency and endocrinology fellowship at Albert Einstein Montefiore medical system. Residency was very exciting but also, as we all know, very difficult, sometimes working more than 120 hours a week, some weeks. I was thrown into the deep end of the pool but I’m proud of the clinician I have become. After residency, I moved to Maryland to be close to the only relative I had in the United States at the time, my sister, and I joined a large group of endocrinologists. That was a good time for me in the sense that I met my husband, who is Korean and, as a matter of fact, today, is a coincidence because today is our wedding anniversary. And we now have two beautiful daughters who are now 10. I worked in this group for nearly 14 years but I always wanted to have my own practice. That was my dream. On April 1st, 2019, I opened the doors to my own practice, Ideal Endocrinology, in Baltimore. I finally felt, 20 years after leaving Romania, that I was living the dream. Everything I have ever wanted was materialized. I was finally practicing medicine the way I wanted. My new clinic is a dream come true. I call it, in my mind, the mutual admiration society. I admire my patient’s grit, their tireless quest for answers, their desire to become healthier and, in turn, better humans. I think, and many of my patients told me so, that they admire me too. I love my clinic so much that on the days when I feel tired or my body aches, I walk into my clinic and I feel better. I think of it as the healing place. I’m board certified in endocrinology and, most of the time, I practice conventional medicine in many ways, but I also integrate many alternative modalities that I have found very useful over the years. I recommend meditation and yoga, journaling and poetry, of course, besides all the board certified endocrinology stuff I do. I monitor my patient’s sleep and their blood sugar with various sensor and I give them feedback often on their parameters so they can manage their health better. I’m the doctor I wish I had when I had my own health challenges. I’ve always practiced this way but, with all of the outside pressures in the revolving door clinic, I felt frustrated. There was never enough time and space to address the whole being, only bits and pieces. Towards the end in the revolving door clinic in my previous job, I felt that I was starting to give my patients what I had to give from a place that was not what I imagined when I dreamed of becoming a doctor. I was giving from fear and resentment, not from genuine care and love.
Kevin Pho: You talk about your practice being an ideal medical clinic. Now, that is a special type of practice. Can you tell me more about what an ideal medical clinic is? Corina Fratila: An ideal medical clinic, I did join the ideal medical movement, which was started by Pamela Wible, but I have my own take on my ideal medical clinic, which is that me and my patients kind of decide together how we want our office visit to go. It’s not necessarily coming from an authoritarian point of view. It’s not necessarily that I’m the dictator or I don’t practice the old model of medicine, but we kind of together decide what the best thing is for their health. We know that the body has an innate capacity to heal and that the patient eventually decides what’s best for them. And I’m there just to guide them and I’m not there to impose my views necessarily. Kevin Pho: And you refer to your past clinic as the revolving door clinic. Corina Fratila: Well, unfortunately, the way medicine is practiced in the United States, there are all these pressures that come from various third parties, like insurance companies and administration. And whenever you have all these practices imposed on doctors and on healers, unfortunately, there’s never enough time. So you can’t possibly spend… Sometimes I spend even two hours with a patient in my clinic. In my previous clinic, if I spent more than probably 20 minutes with a follow-up, I couldn’t have made it. Kevin Pho: Let’s transition into your KevinMD article. Are physicians a steward of healing that they are meant to be? Now for those who haven’t read the story in your article, can you just walk my audience through it and share the reasons why you decided to write it? Corina Fratila: In my new clinic, one of my patients reported symptoms that made it clear that she needed surgery, which is not something I was trained to do. I had to refer her out. I referred her to one of the local medical institutions, a big local name, just because prior to going into practice on my own, when I was part of the large group, this is where I used to refer my patients for surgery. The experience that my patients had and reported to me was terrifying. From the first step she set in the big name clinic, she experienced nothing but rude, arrogant, condescending, and insensitive comments and behavior. Of course, the fact that she was seeing a back alley doctor as an endocrinologist, as a lot of the doctors in private practice are seen these days, did not help.
A doctor who recommends dietary interventions and know her patient’s lives and family and intimate detail, who actually spends time listening to the patient and the family and tries to make sense of the whole picture, not the welcome sight for the big name clinic doctors. The patient and her mother were dismissed in a rude and abrupt fashion. Her symptoms were discarded. Her quest for answers was trashed. She was made to feel small, insignificant, ignorant. She was recommended to never see her fringe doctor again and to just go to the big name clinic for treatment. My article looked at this question, explored this question of the lack of collegiality and the lack of intraprofessional respect that bleeds into patient care. I used the same referral sources as previously, but I am treated completely differently now that I have my own private practice. Let me tell you how other doctors have reacted to me opening my own clinic. I notice two types of responses from doctors, the jealous, dismissive, shunning crowd, and the curious and excited group. I have actually received a letter from a patient who is also a physician, who mentioned that she’s never met such a happy doctor before. The culmination of this, let me show you how this played out for my patient. I can handle doctors being happy or jealous of me because I have thick skin. But when this bleeds into patient care, I think it’s unethical. I sent my patient to get surgery and this is a referral source I used for years. Now, that she is coming from my small private clinic, she was shunned and dismissed. I think this is a crisis of intraprofessional respect. And the fact that it bleeds into patient care is huge. And, of course, this is just a symptom of a bigger problem of how sick our healthcare system is. I think we all, as doctors, we need to practice what one of my favorite authors calls, “Enlightened humility,” which in her words means that… Of course, we know somethings because we went to school for so many years. Of course we do, but there is a whole other world that keeps revealing itself to us and we need to remain open to that. We need to remain fluid and porous and nimble because we need to meet the time, the reality of the moment we’re in. And all of us as healers, we need to stay in this enlightened humility, which is a really hard thing to do. Kevin Pho: Now, when you were referred to as a back alley doctor, what was your reaction and what was going through your mind when you heard another doctor call you that? Corina Fratila: Well, I was a little bit sad. I was a little bit upset but, for some reason, it became very clear to me that this was literally a symptom of the times. It was a symptom of what was going on. And the fact that generally my patients and I have such strong relationships, of course, that helps clarify things for me because the patient didn’t mention that to me to hurt me in any way. She just mentioned it as a matter of fact and also as an observation how terrifying it is for a patient to spend time in a big clinic that doesn’t really put the patient at the center. And it’s more about politics and more about lack of, again, intraprofessional respect and almost like the patient didn’t matter at all. Kevin Pho: Now, was this an isolated occurrence or does this happen regularly? Corina Fratila: Well, this was the first time it happened to me, but I’ve heard it happened previously from other physicians going private practice. Kevin Pho: Now, what are some of your suggestions to improve the communication and the respect between the big name centers and the smaller private practice clinicians?
Corina Fratila: Well, just as simple as picking up the phone and making a phone call, that’s something that literally would take how long? A couple of minutes. But someone, particularly with my background, very much understands how… I mean, it’s almost like this is… It’s corrupted. The system is corrupted and this can sully the whole system, a whole profession. This lack of collegiality, the competition, that suspicion that is present doctor to doctor, it’s very concerning because I know, I know where this can lead. And the physicians who think that they’re playing harmless games or politics, it’s danger because it’s not just the life of the colleague they’re affecting but the health of the patient. Yeah, it’s as simple as, even if you hate talking on the phone, which I know a lot of us hate talking on the phone these days, send a text message, send an email. It doesn’t take long. Kevin Pho: We’re talking to Corina Fratila. She is an endocrinologist and she wrote the KevinMD article, Are physicians the stewards of healing that they are meant to be? Corina, once again, you talk about the ideal medical clinic that was created by Dr. Pamela Wible. Now, for those physicians who may be working in large centers and considering transitioning to such a smaller practice, what are some factors that you need to consider in that decision making process? Corina Fratila: A very important factor to consider is having a low overhead because having a very low overhead, that means that you’re free. Living simply and, just generally, living simply at work and at home and just… It’s really the key to freedom. The other thing is that we all need to learn ways to overcome our fears, in order to grow and flourish. Of course, fear will always be there but we have to learn ways to overcome and move on. For me, that has been priceless. The other thing to consider is that we, as doctors, I think we are all entrepreneurs or, at least business owners at heart, and this has been kind of squashed out of us doing medical education. We have been taught to live in fear and this mentality of scarcity and fear has completely overwhelmed us and it’s almost like we can’t see outside the box. Kevin Pho: And my final question, what is your take home message that you want to leave with the KevinMD audience? Corina Fratila: That I think it is up to all of us to recognize that the current system is designed to keep us small, imprisoned and robot like, and it is designed to very gainfully exploit the empaths. It’s up to every single one of us to remember why we became physicians and that we are not providers, we are doctors and we’re healers. And once we overcome the victimization produced by exploitation, we will remember that we can be our best selves and give from abundance and not from fear and resentment, that we are the creators of our lives and we shouldn’t be giving our power away to anybody. And I also want to leave the audience with a question. I don’t really have the answers but maybe some people will. How can we thrive without burning ourselves into the ground or tearing other people apart in the process? How can we lead and achieve in a more elegant and loving and joyful way?
Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show. Corina Fratila: Thank you.