The Good Ole Days of Knights and Knaves

I am reading more and more articles about what I like to refer as ‘the good ole days’. It reminds me of the stories our parents used to tell us about walking to school in 2 feet of snow uphill both ways. This generation is soft, soft I tell you. The problem is I am starting to tell the same stories to my kids about how easy their life is and how they need to struggle a bit more to truly appreciate it. The same is true of medicine. Remember the days when a doctor patient relationship meant something? Our patients really trusted us and followed our advice instead of bringing in internet searches and asking for the MRI to diagnose whatever condition ails them. 

Well let’s not be so critical of today’s medicine and the promise it has delivered and provides for tomorrow. We can provide amazing treatments for our patients. Advances in surgery and medicine have reduced death rates from just about every major disease and injury category. Doctor’s income is (and has been for quit some time) at the high end of the scale when compared to the general population. That is certainly the case in America. It is one of the reasons so many physicians yearn to live in the US so they may have access to the level of material success. The issue becomes when we equate the level of material success with what is ‘owed’ to us.

The tradeoff for that material success appears to be more lawsuits (and as a result more defensive medicine); more demands from our patients to get the diagnosis right the first time (even when we know that is not a realistic expectation) and an attitude of entitlement (that cuts both ways). If the above didn’t upset some of you, then I need to stop writing and see some more patients.

I would like to offer a counter argument. One which was eloquently stated in a recent New York Times article I read.

As referenced in the article we have a choice as physicians and health care providers to be either the white knights or the knaves as our system changes. I genuinely believe that is indeed a choice. It is a choice each of makes when we take a deep breath, walk into a patient’s room, sit down (hopefully) and ask how can we help them. Do we smirk as we walk into a room with a patient with back pain and had several previous visits for the same? Do we give them the benefit of the doubt, every time, that this time something is legitimately wrong and we are going to find it and treat it? Will we choose to be the knight or knave in this circumstance? It is not always easy. Being a knight often is not.

I fall short of this ideal on a regular basis. When I recognize it, I make a conscious choice to change my mindset. I believe that our group of over 125 practitioners in emergency medicine strive to be knights. I look at the lives we have touched over the years and health of the communities we serve improved as evidence of the choices we make. I think that is true of most physicians and health care organizations.

I attended a breakfast recently about other knights of healthcare. It was a breakfast to support Mercy Health Clinic in Gaithersburg, MD. The clinic provides free medical services to some of the 130,000 uninsured citizens in Montgomery County. The entire staff is volunteer; physicians, nurses, translators, registration and support. Check out their website at for more information.

The easiest thing in the world to do is look at a situation and see all the flaws and where the processes (or patient) fall short. The much harder thing to do is to shake off all the preconceptions and look for that strand of gold in the pile of straw before us. I guarantee you it is there. In the short term there will definitely be some bumps in the road. For the physician, health care provider, group or organization that takes the time to look at it from the patient’s point of view and what is best for them in the long run, the rewards will be great.

Knight or knave? It really is our choice.