A Doctor's Vanishing Dream

TV and movies have often focused on physicians, truly part of the country's entertainment landscape. There have been certainly enough fictional "doctor" shows over the past five decades, from Dr. Kildare to House, with barely a glimmer of reality attached. As for reality, Michael Moore's 2007 documentary Sicko, touched on physicians, but mostly as a sideshow to his major viewpoint of the U.S. healthcare industry's flaws compared to the rest of the world.

But the underbelly of a doctor's lot: billing codes, malpractice, their feelings about patients, patients' feelings about them, the frustration of only having 10 minutes to give to a patient — haven't been given truly much focus on TV or movies.

At least that's what Ryan Flesher, MD, was thinking. To give his perspective to a doctor's life, Flesher spent four years directing a documentary, "The Vanishing Oath" produced by Nancy Pando, LICWS and released by CrashCartProductions.

Flesher's story is about himself, and also other physicians caught in the whirlwind of the healthcare system, their day-to-day exhaustion and unhappiness woven in a tightening bureaucratic vice. The film was the result of interviews with hundreds of people, not only doctors themselves, but patients, academics, lawyers, and others. It is often sad, but occasionally inspiring.

Flesher, 37, who worked in a Boston hospital emergency department, leaped at the chance to make the film after increasingly becoming unhappy in a system that seemed to unravel, becoming "critically wounded," he said, with doctors bailing out of their chosen profession, because they weren't able to have enough time: for their patients or themselves.

Flesher hated being a physician in a manner that he says the system demands. "It was just pretty frustrating," he says. "Since I was young, I focused on becoming a doctor." Over time, as he grew more unhappy, " I began asking myself, 'what's wrong with me, why am I so unhappy? After four years of filming, it educated me and brought me to a better place. I wasn't alone, there were thousands of people who were also frustrated, their hands were tied by the system, and they were discouraged."

Flesher dubs it the first "physician focused" documentary, and it's good for health leaders to see it from that prism.

On one level, we know the story. Questionable procedures. Too much paperwork. The costs of malpractice suits. Upcoming doctor shortage.

In Flesher and Pando's hands, however, the facts of being a doctor in America today become wrapped not only in numbers, but also in emotion.

It's sad to watch physicians weep with despair over their profession, trying to wring some time for themselves or their families, and frustrated they can't see most patients beyond what their charts tell them, and the few allotted minutes in their schedule. It's exhilarating, however, to watch a few select physicians who say they will never give up on the dream.

And that makes the documentary more riveting because doctors tell intimate details of their profession as they see it. Some of those emotions might not make it to the C-suite on a day-to-day basis, while physicians make the rounds. It's emotions that health leaders should see.

By injecting himself, Flesher does a sort of Michael Moore routine, but he's no wise guy. Just an exhausted emergency department doc. When they began filming, Pando says Flesher's "eyes were hollow."

One day, Flesher talks to the camera, as he sits in his green scrubs in the hospital where he was working.

"We're just jammed, ambulances everywhere, beds full, I'm carrying 16 or 17 patients of my own, pretty sick," Flesher says in the documentary. "Before I go three steps, I'm confronted with the billing agent for the ER who says we can't get paid because my charts — eight of nine — required review assistance components. Two, I'm confronted by the service rep for the hospital (who says) my patient satisfactory scores are only 93% - we've got to be above 96."

"The CEO says we are getting backed up (in the emergency room), and we need to get patients through the ER quicker," he adds. "The Joint Commission rep says she caught me drinking three feet too close to the patient care area and she's going to cite me for—whatever. I didn't even see a patient yet and my mind is already clouded."

As he began working on the film, Flesher found out many others were disheartened, and he felt the system failed them.

"The obstruction of physicians and its direct effects on healthcare are far more profound and potentially devastating than I'd imagined," he says.

In his journey to find himself, Flesher seeks out an older and accomplished physician, Peter Rosen, MD, who has received numerous awards in the field of emergency medicine. He expected Rosen to be stodgy. He found otherwise. He found a wise man.

"I think you can work to prevent (burnout)," Rosen says. "The important thing is to revive your ideals — why did you want to be a doctor? Because it still exists, no matter how many hidden agendas you have to meet at work, no matter how many stupid pieces of paper you have to fill out."

"Despite that, I can still have fun taking stitches out of that 5-year-old kid and joking with him for a minute and a half."

Rosen's inspirational comments run through Flesher, but they last only so long.

Now out of residency for 8 years, Flesher left the hospital and became a traveling, part-time physician, "to get more time and flexible schedule" to carry out interviews and make the film. He is working mostly in Pennsylvania and West Virginia.

Flesher's wife, Kathrin Allen, MD, is an anesthiologist. Does she agree with the film? "She does for the most part," Flesher says. But she's only been in practice for a year and a half, and, Flesher adds, "isn't so jaded yet."