Retired, Assistant Clinical Professor Psychiatry, Case Western Reserve University School of Medicine, USA
Received: November 11, 2015 | Published: June 02, 2016
Dr. Samuel A Nigro M.D, Retired, Assistant Clinical Professor Psychiatry, Case Western Reserve University School of Medicine, 2517 Guilford Road, Cleveland Heights, Ohio 44118, USA, Tel: 216 932-0575; Email:
Nigro SA (2016) Why You Are Stupid to go to Medical School. J Psychol Clin Psychiatry 6(1): 00325. DOI:
“We have a socialist communist system of distributing health care.”
Economist Milton Friedman (This is an outrage to those of us who served in the military for the Cold War against the Soviet communists. I want my three years in the US Submarines back!)
You are a fool to go to medical school today ... that is, if you want to take care of patients. In brief, you will be a slave working without full payment or self-control, and you will not be a full US citizen entitled to free enterprise. Regardless of your ideals and lofty aims, medicine is no longer a “profession” – It is not even a trade in that you could not strike if you wanted to. Medicine is a slick, contemporary form of slavery in the United States—or at least indentured servitude. Oh, you will be able to take care of a few patients and have the gratification of seeing them get well, and you may be able to pay off your medical school loan and raise a family after 20 years or so, but it will be nothing like the genuine Hippocratic traditional practice of medicine—wherein you can be committed to your patients and be able to listen and treat therapeutically as well as be paid adequately without hassle for services provided. But whatever your dearest fantasies and dreams are about healing the sick and relieving suffering and making a comfortable living, sadly, it will not happen. Actually, medical schools do not care if it happens anymore.
The American Medical Association. You will be working for everyone but yourself and your patients. This is because the American Medical Association (AMA) has been co-opted by the health insurance industry junta. The AMA has become a multimillion dollar business publishing code books and administrative control techniques so that physicians are deprived of the free enterprise system. And the AMA’s Ten Principles of Medical Ethics would let you run a concentration camp and an abortion mill. The AMA has sold out and is a fraud of what it used to be. The most it really cares about after its publishing business is malpractice insurance—all the rest is public relations glitz.
Medical Schools. You will be working for everyone but yourself and your patients. This is because medical schools have sold out the Hippocratic Oath which can only be really effective if physicians and patients are free and independent and deal primarily with patients and each other. Now, the Hippocratic Oath only enables the HMB i.e., the health megabureaucracy (the government and private health insurance industry), to shame or force doctors into giving free care. Basically, medical schools have become creators of stooges for the government and the health insurance industry, the goal of which is to pretend to provide health care, brag about it, and exploit both patients and doctors. To be honest, the HMB should take over medical schools—which will doubtless become non-functional after several years, like most everything else the government does which it should not do. That would serve right all these grandiose politicians, who do not give a damn (they never ask) what doctors think or need. And after a few years of these medical graduates, it will be safer to go to your barber than to your doctor when you are sick. Yes. The barber surgeons will return.
Medical Charts. Your medical care will have patient charts filled with useless administrative papers making privacy to be a joke. There will be a deluge of requests for information by groups too lazy, too cheap, or incompetent to do the work themselves so they rely on your information, which later will be claimed to be not good enough for you to be paid. You will not be allowed to select your own service and diagnostic codes unless agreed upon by HMB deadbeats, and their choice of codes will shortchange you. There will be ridiculous Big Brother printouts of all the meds the patient has ever taken with recommendations to save the HMB money (I always gave these printouts and anything else received to the patients and asked them to write those who sent this phony pharmacy and other junk demanding corrections as well as requesting explanations about something inane. The patients hardly ever hear back—Just like all big administrative crooks, the HMB does not have to respond to all questions received while demanding you do. If every body asked them a zillion questions, they would go nuts. DO IT! I learned in the Navy that two can play this paperwork game. On the other hand, the HMB does not really mind because they can employ more do-nothing busyworkers that way and inflate themselves as “bigger.”). There will be notes from busy groups galore...Medicare, Medicaid, Workers Compensation, the FBI, employers, schools, social service organizations, pharmacy management groups, courts, lawyers, loan agencies, home repair services, apartment houses, the gas, phone, and electric companies, and transportation companies, and it seems everyone wants a piece of paper from you about your patient. Whatever you write will likely be good enough for all, except for those who are supposed to pay you. Regardless, your fees will be routinely contested requiring you and your office staff to beg and crawl like administrative lap dogs whimpering to robotile phone or paper shuffling health care authorizers who are medical idiots not caring at all about real care—their job is to block or delay payment by keeping you on hold, by menu instructions that go nowhere, by fax phone numbers that do not work, and by useless busy work protocols developed by employed traitorous physicians who failed in trying to do what doctors regularly do (so, naturally, they work for the HMB). You will subsidize the HMB by having to hire secretaries to do tons of billing paper work which the HMB should be doing. The HMB will almost always find a mistake requiring rebilling...this will be done three times for most bills before you can get paid—and it is all a contrived administrative fraud to delay or prevent prompt payment (The HMB could not function if it collected its premiums the way it pays its bills). You will want to take care of patients, but more and more you will become an angry bewildered frustrated physician spending an outrageous amount of time doing administrative office crap mumbling over and over “I did not go to medical school for this” instead of caring for patients. And those medical school loans....you will have them for a long time—the HMB will see to that...it keeps you dependent on them.
Secretary for the World. You will not be a practicing physician but a secretary for the world for health care, providing private medical information to an army of intruders into that care. As a physician, you will be in an administrative police state closely scrutinized by second guessing “I could have done better...” “Why didn’t you do...?” “You should not have done....” ”You do not need to do...” ”Prove to me that the patient really needs...” from lawyers, reviewers, authorizers, judges, reporters, and pharmacists. And if you complain to the state insurance authorities about Medical Mutual, for example, you will be fraudulently investigated by deep pocketed Nifongs who will ignore recent audits which found nothing. The main role of all these intruders into your practice will be to maintain their busywork jobs for themselves, to parasitize and intimidate physicians and to delay or prevent payment under the glib denial that such was necessary for your care of patients. You see, to create problems is to create their jobs—that is the HMB.
Pharmacists. You will be hounded and badgered by all, including pharmacists who are frightened of their own shadows having become police state Pecksniffians following the Big Book of Pharmacy which is outdated, incomplete and partially incompatible with good patient care. Pharmacists will unethically (Actually, pharmacists have no ethics) and anti-therapeutically abuse your patients who will regularly be made to feel worse than when they arrived at the pharmacy. You will waste an incredible amount of time talking to pharmacists over one inane question after another allegedly necessary for them to dispense the medicines. You will have to help your patients deal with pharmacy abuse—some patients will want to commit suicide and even kill others in a rage after visits to pharmacists (It is only a matter of time when an enraged patient will wipe out a pharmacy—that is neither a suggestion nor an apophasis but a prediction). Your letters to the Pharmacy Board will do nothing, because it tends to be filled with implementers of 1984 (the book) or else with frustrated flim-flam physician wannabees mad at themselves and everyone else. Pharmacists have become a know-it-all, arrogant, second guessing, show-boating, self-importance-creating group caring not about patients but about “pharmacy rules” which, if physicians had to follow, would be dangerous to patients’ health. Stupidly thinking medications are interchangeable, pharmacy management groups will want to change and substitute your prescribing in order to save the HMB money, when the real way to save health care dollars would be to shut down the HMB. Thinking they know it all, pharmacists will badmouth you and your patients, jeopardizing the doctor-patient relationship and injuring patients by creating anxieties and aggravating mental states. Pharmacists neither know nor care about anything except Big Brother Pharmacy Board supercontrol such that all patients are crocks and all doctors are crooks. The most enjoyable part of being a pharmacist now is that feeling, right or wrong (usually “wrong”), of “Gotcha!” (Mike Nifong also lives in pharmacy land!). Most of these pharmacy crimes are linked to HMB schemes to obstruct care, to delay or deny payment, or to force patients to pay for the prescribed medicines themselves. The HMB has turned “pharmacy” into a public health hazard.
PIFATOS. Occasionally, but not frequently enough to matter, patients, if well attended, will be grateful and loyal to you for responding to their needs. After I quit most of all the HMB and had my patients pay at the time of service, I was gratified and flattered that so many did so. Not needing any clerical help, they pay me and I give them a receipt with diagnosis and service code telling them, “You fight with your insurance company idiots yourself...and write the state insurance board and governor if they will not reimburse you...it will cost them to write defending themselves...serves ‘em right.” If you are good with your patients, they will come up with the money. Indeed, if you want to treat patients, the only way you can really enjoy the practice of medicine today is: Payment In Full At Time Of Service (PIFATOS)—That should be the only administrative payment method for outpatient medical care allowed by law. Until then...forget about medical school!
Salaried Positions. Oh, you may get a salaried position which seems good. But you will be beholden to many and taken advantage of terribly, because it is an absolute loss of automomy and deprofessionalization without the advantages of employment law. All the benefits your employer will offer, from baseball tickets to retirement plans, will have loopholes leaving you nothing and likely unable to practice within 100 miles upon your leaving them for whatever reason. And if you hang on, your employer will gradually squeeze you for fees, for memberships, for insurance, for donations, for extra unpaid work, for more service for less, and for whatever they can extort from you. Salaried positions are a bait and switch slow burial. Most will be sorry.
Bad Patients. Usually, by law, you cannot unload deadbeat problem disrupting patients without extensive documentation. So I have my patients sign a treatment agreement which includes they have automatically fired me as their doctor, if (1) they fail two consecutive appointments without sufficient notice; (2) payment is not made as reasonably billed; (3) a complaint is filed without being processed or arbitrated with me; (4) medications are misused; (5) controlled medications from another source are obtained without informing me; (6) an appointment is not made and kept at least every six months; and/or (7) they have personally mistreated or abused me. That you are married to your patients until you follow a long legalistic divorce process is a form of slavery.
The Parasites You Will Carry. Here is a partial list of parasites you will carry on your back: (1) Law schools parasitically flourish because more and more attorneys can be graduated because they will be able to creatively impose more and more anti-professional legalities on your practice. Soon you will need a lawyer or court reporter present for every patient visit. (2) The HMB will parasitically receive at least $600 billion dollars (more than the defense budget) each year from you and other physicians. Those dollars do not change a bandaid, but go to the HMB: to CEOs earning thousands of dollars an hour, to other parasitic executives, to bewildered auditors, robot reviewers, Nifong investigators, and to an army of desk jockeys—none of whom deserve a dime of those health care dollars. (3) The private health insurance companies parasitically pay out your patients’ health care dollars to stock holders, which is an absolute obscenity—years ago I instructed my retirement plans never to purchase any stock in any health insurance company—I would not call the fire department for any of them. I will not provide care for anyone who works for the HMB. Let their hired consultants take care of them—that way they all can die in house. In fact, there ought to be a law that all employees of the HMB can only use HMB consultants for their health care (at which time we all should buy stock in funeral homes). (4) Politicians are parasites by their using medicine as a dance floor on which they pompously prance and preen claiming health care for all by sub rosa communism with the exclusion of a minority group (physicians) from the American free enterprise system. And they do not give a damn what physicians think either. Basically, politicians are either pimps or whores for the HMB, and one cannot be more parasitic than that. Look at Hillary—she wants a nazi-communist system second to none with her cronies in charge. You have to be stupid to go to medical school with her ilk in the wings.
An Army is Against You. You will never be able to deal comfortably or efficiently for long with the HMB because it is an army of administrative thieves and communists whose jobs are to make empty bags for you to hold. That is, once a critical mass of physicians figure out how to use the system effectively, it will be changed. Period. There is always a new hotshot jackass administrator with a better idea on how to rip off physicians—and he will make the new HMB rules to be imposed. The HMB will solicit patients promising everything but they will refuse to pay without useless reviews by people who could not provide the care. There will be deliberate delaying of payment for what you do as a physician whether your patient gets well or not. The health insurance industry develops, finds, and fabricates reasons to delay payment or just not pay. Basically, if the health insurance industry collected premiums like they pay appropriate bills, they would be broke.
The Legal Profession. You will discover the legal profession is a joke usually having little to do with justice but with show business and suggestibility. Nomogenic disorders (“lawyer made diseases”) are present as an epidemic by spontaneous generation. “Lawyers” are ripoff exploitation experts totally self discredited because their income is directly proportional to the messes they make and then pretend to clean up for and with each other—it is called “mutual job security.” “Judges” are ex-lawyer political hacks, arrogant in the permanence of their jobs, wondering all the while about nothing except “looking good” to the press and media. “Expert witnesses” are dummies mouthing whatever ventriloquist lawyers have paid for. Indeed, the integrity of the legal profession can only be re-established by a book of fixed fee codes for every completely documented service—It happened to medicine; it must happen to the law. In terms of direct patient care, the legal profession is a parasitic plague.
Your Only Friends. The only real friends for physicians are, and hopefully will continue to be, pharmaceutical companies. This will be so until private health insurance companies take over pharmaceutical companies which should be against the law. You will never be more happier that you are not a physician than when the king of thieves, Medical Mutual, takes over Pfizer. One can only hope that Pfizer et. al. will take over and Americanize Medical Mutual and all the other nazi-communist private health insurance companies injuring the people.
Pretending Will Not Work. As a potential student, as a medical student, and as a physician, you will try to rationalize all this away, make nice, and pretend all is well. But sooner or later, you will recognize all this is true. You will regret becoming a physician. You will wish you never had. You will look for other work and if you are honest, you will tell everybody you know.
Fake Physicians. There are a few exceptions and these are basically the physicians who have sold out and who are employed by the HMB itself. These pseudophysicians forgot why they went to medical school and will give you a “song and dance” routine worthy of “The Sound of Music.” Do not believe them. They are “administrative physicians” which really means they have failed clinical practice and found a fake medical niche in which to survive as a “so-called physician.” Administrative medicine is inversely proportional to clinical expertise. Period. Half of them could not find a bleeding elephant in a snow drift. Any doctor who works for the HMB is a traitor to the Hippocratic traditional practice of medicine and to the profession of medicine itself, or whatever is left of it. These creeps do not deserve the title “M.D.” Never call them “doctor.” Never address with “M.D.”. Use “hey, you” and first name only.
Dumbing Down is Here. If you are smart, you will not go to medical school. Dumb people will, and that is just what the HMB wants. It is now a downward spiral. Your ideals will be overwhelmed. And no one cares. But they will when they get a dumbass doctor (probably a “should a been a pharmacist” who cannot figure out that he is neither free nor a full American citizen—He will fix them fine—they will die young.
Leaders Who Have Sold Out. In closing I must remind that there is a pattern here in the genocide of physicians and medicine as a profession. Scholarly, mild mannered, erudite gifted and talented leaders established and maintained rapport with the brutal enemy universally encouraging compliance all the while “hoping for the best.” And such always has been and always will be a disaster. This pattern has happened once before in a much more malignant way, and is well described in Zygmunt Bauman’s book: Modernity and the Holocaust. When leaders sell you out; enable administrative control; encourage compliance and cooperation; use group pressure to overcome moral and ethical matters; censor, shame and ostracize those who object; dilute and diffuse responsibility; use technology to blunt morality; authorize questionable actions as routine; conceal adverse outcomes; argue pseudo-rationally and rhetorically; counsel “hope for the best” or “save what you can;” use science as a bludgeon to dehumanize and kill the conscience; and mouth grandiose purposes to achieve utopia pretending “it will be all right,” not only will a profession of hundreds of thousands of physicians die but, by the same type of leadership, millions of people were murdered. Read Bauman’s book! His answer was and is, in one word: Defy! (The Jewish leaders should have counseled fight, run, and disrupt; make it difficult for the enemy; kill when you can; make them suffer and work hard to get you; it will be horrible and the outcome may be the same, but evil should not have an easy way. The estimate is that half of Nazi murdered Jews would have eeked out a survival had they not listened to their leaders who made it easy for a few Nazis to kill millions! If the Warsaw Uprising happened everywhere, the Nazis would have had to stop and never would have murdered as many as easily as they did.)
DEFY! DEFY! DEFY! You will have to act ala Winston Churchill: Defy by pretending to go along but sabotage all you can. Defy by withdrawing from all Medicare, Medicaid, HMOs, Medical Mutual (for sure), and all the other goose-stepping communists who have taken over medicine. Defy by PIFATOS. Defy by promoting Health Savings Accounts for yourself, your family and patients. Defy by refusing to comply...or at least create administrative mischief day in and day out with one question after another. Defy by accepting no fax or phone calls, but letters only. Defy by having your staff, during slow times, make one nuisance call after another to the HMB asking for written responses and clarifications. If you know a computer geek, defy by disrupting HMB computers. Defy by giving wrong identification numbers for your small amount bills making them waste time correcting your fabricated mistakes (That is what they do. What goes around, comes around). Defy by asking for copies of all the signed contracts of each and every patient (“for the record” of course) and all the organizations’ rules at least twice a year—then pitch it—and have each of your patients do the same (They are entitled to all this!). Defy by asking for CVs and backgrounds of all non-physicians who communicate with you about patient care. Defy by demanding “universal care” be defined as “the universal immediate payment upon receipt of any and all medical bills.” Defy by stinking heavy “radiation” marked packages from no where? Defy by never referring to physicians (or Leviathans as the Cleveland Clinic et. al.) who collaborate with the HMB nazis and communists. Defy by selling and bad mouthing all private health insurance company stocks. Defy by never supporting and refusing to have anything to do with any organization that has a HMB executive on its corporate or overseeing board. Defy overtly and covertly—lie to them—say “yes” and forget about it; set up lunch meetings but have an “emergency” at the last moment. Never go to meetings where they are presenting as set up by AMA finks—register, but do not show. Defy by returning all their mail except payments. Defy by not going to medical school until the system has changed. Or if you do go to medical school, defy by working to institute the “White Paper On Medical Financing” (Journal of American Physicians and Surgeons, 11, 3: 86-91, Fall 2006 and on internet at "http://www.jpands.org/vol11no3/schlafly.pdf" http://www.jpands.org/vol11no3/schlafly.pdf and “Patient Care” from "http://www.cesj.org/homestead/summary-cha.htm"
http://www.cesj.org/homestead/summary-cha.htm; Until then, you are stupid to go to medical school.