Do Patients Really Know What Physicians Do?

As I pored over my Twitter feed last week, I was struck by the number of physicians piggybacking off each other’s “What do you do?” tweets. At first, I chuckled. Then, I got pensive. I realized that these tweets might be spotlighting a perturbing question:

“What do you do?”

“I’m a General Internist.”

“What’s that?”

“I treat adults with multi-system, complex diseases, uncertain diagnoses, some critical care. My interest is in bedside ultrasound.”

(Blank stares)

(More blank stares)

“Have you seen House? I do that. I’m House.” https://t.co/Sqw5U1VbIh

— Katie Wiskar (@katiewiskar) June 6, 2018

Do people really know what physicians do?

It may seem ridiculous at first, but think of it like this: For most people, physicians are the first humans encountered upon exiting the womb. Physicians are not only present during many people’s births, but also their deaths, and many of the profound moments of sorrow or joy in between.

An injury? An infection? An accident? An addiction? Weight lost? Weight gained? Birth given? Birth taken? A quick recovery? A slow descent?

A physician will be there to guide you.

But still, these tweets are a repository of anecdotal evidence suggesting that many people are unsure of what doctors do, which is by my estimate a clear reflection of poor health literacy. If it is a health literacy question, then anecdotal evidence in the tweets is supported by the literature — just take a look at this health literacy data map from the University of North Carolina at Chapel Hill, which estimates that 22% of the US population has only basic health literacy, and 14% have health literacy that’s below basic.

There’s no indication that the algorithm the authors used to make these estimates included questions about patient understanding of what physicians do as a factor of health literacy, but can we really expect patients to understand the difference between a pediatric palliative care specialist, an internist, and an obstetrician if their health literacy is so poor they can’t identify the information they need to stay adherent to their insulin?

As Howard Koh, MD, MPH and Rima Rudd, ScD, MSPH wrote in a 2015 editorial, “It’s a troubling paradox. In the midst of rapid expansion of medical knowledge intended to benefit many, too few actually understand medical information well enough to improve their health.”

We can take this a step further. Not only do many patients lack knowledge about what physicians do, they also hold misconceptions about what it means to be a physician. Many believe that doctors are inherently wealthy, perfect decision makers with enviable lifestyles. The truth is, despite their above average salaries, many doctors are in boatloads of debt. Despite their years and years of training, they often make mistakes. And despite the fact that they could live luxurious lifestyles, many physicians hardly feel like there’s a world outside of the hospital or clinic, and are feeling increasingly burned out and suicidal.

What if there was greater awareness of the supreme effort needed just to get through medical school and internships? What if more people were cognizant of the integrity, fortitude and stamina necessary to handle the everyday hardships of being, say, a trauma surgeon or palliative care specialist? What if we could tally all the pandemics that infectious disease specialists and epidemiologists have prevented?

If we could, then physicians might be lining up alongside police, firefighters and military service members during the next national anthem, because without doctors, the world would be a much different, much more dangerous place.

"What do you do?"

"Anesthesiology"

"Oh you put people to sleep"

"Well what's more important is I make sure they don't die and wake them u--"

"And you make a lot of money"

"..." https://t.co/nNLNelAdxq

— The Gay Burn Book (@SouthernHomo) June 6, 2018

"What do you do"

"I'm an ophthalmologist"

(Silence)

"I'm an eye surgeon"

"Ohhhh...I have astigmatism" https://t.co/jZeIxO6Zlr

— Dr. Glaucomflecken (@DGlaucomflecken) June 6, 2018

“What do you do?”

“I study health effects of drugs and alcohol”

“Oh” [tries to slooowly hide 3rd beer behind back]

“I’m not judging you, you know” https://t.co/U4h1pG6HSe

— Esther Choo (@choo_ek) June 5, 2018

"What do you do?"

"I'm a family doctor."

"Oh, so how much longer do you have in school?"

"I'm done with school."

"Oh, that's great! Are you going to specialize?"

🤦‍♀️ https://t.co/V4k3tdvCiu

— Clinical Pearl (@ClinicalPearl) June 6, 2018

“What do you do?”

“I’m a pediatric palliative care fellow.”

“Huh?”

“...like hospice...”

“Oh! That’s so sad! You must be such a good person!”

“I...”

“It’s just so sad. I don’t know how you do that. You are such a special person.”

“I’m saying I’m a pediatrician from now on.” https://t.co/EJhi0o2fM6

— Emily Hahn (@TexasKidDoc) June 6, 2018

"What do you do?"

"Interventional radiology."

"?"

"I put needles and catheters into people with live image guidance. Biopsies, embolizations, angioplasty, that kind of stuff."

"?"

"I'm a surgeon. It's just like surgery but better."

"Cool. Can I ask you about this rash?" https://t.co/pNhHOL4t2C

— B. Bobby Chiong, MD (@brianchiong) June 5, 2018

“What do you do?”

“I’m an emergency physician”

“OMG you must see so much crazy trauma”

“Well actually it’s mostly old ladies and dialysis patients and...”

*eyes start darting around*

“Yeah tons of crazy trauma...” https://t.co/LzCJAJubhp

— Ben (@be_nMD) June 5, 2018

Editor’s note: This is a column written by Tom Castles, associate director of editorial. His analysis reflects his views, not necessarily those of the magazine.