The Vanishing Oath: A Review

Yesterday, a much-anticipated package arrived in the mail containing a documentary film directed (and acted) by a young emergency room physician, Ryan Flesher, MD and produced by a former clinical social worker, Nancy Pando, LICSW entitled "The Vanishing Oath."

As background, the film is a three-year project born in 2007 just before the great US health care reform debate began. Over 200 hours of interviews were conducted explore a simple question: why Dr. Flesher had grown to hate medicine.

It would have been easy for Dr. Flesher and Ms. Pando to make his story nothing but a rant, but instead, we find that their story is an honest attempt to understand how someone so enthusiastic at the start of their training could become so quickly discontented with the realities of emergency room care and our bloated health care delivery system.

To understand the origin of his disillusionment, we journey with Dr. Flesher and Ms. Pando as they return to interview people on the street, his family, fellow medical students, mentors, scholars, colleagues and plantiff's attorneys. They attempt to interview many of the many "vested interests" involved in our current health care system, including:

American Medical Association
Many insurers, including Blue Cross, Aetna, Cigna
Three congressman
Six state representatives
Many hospital administrators and 11 Boston-area hospital CEO's
The Joint Commission
Dr. Groopman, author of "How Doctors Think,"
Ewe Reinhardt, medical economist
Regina Herzlinger, Author of "Who Killed Healthcare"
Press Ganey and
Five CEO's of major drug manufacturers.

Of those that responded to their requests for an interview, all wanted to see the questions beforehand. Ultimately, none of them opted to go on record in the making of this film.

The viewer is left to wonder why.

Still, they manage to gather a few insightful interviews from those with health care administrative backgrounds. More importantly, we quickly realize that Dr. Flesher is not alone. The same forces that shaped his discontent are revealed in fourth year medical students unsure what lies ahead for them and in the colleagues he turned to during fellowship training. We are introduced to a young aspiring hand surgeon who left (video clip) medicine after all of his years of training because of the toll it took on himself and his family. The footage is powerful. The people and emotions, real.

Suddenly, the viewer is confronted with the reality of how our health care system has grown to affect doctors. Worse, we realize what this might mean to each of us.

Additionally we see, firsthand, the effects that the fear of malpractice has on doctors and their behaviors. More to the point, we hear (video clip) from several doctors who had been sued and are even ushered into the office of an anonymous doctor in the midst of a suit at the time. Only later, and contained in a separate clip contained on the film's DVD, do we learn that the anonymous doctor interviewed was doctor Robert P. Lindeman, MD, the no-longer anonymous physician blogger former known as "Flea" as he was being tried in court just before he was unmasked on the stand by the prosecuting attorney. (A remarkably insightful follow-up interview with Dr. Lindeman a year and a half after his trial was settled is included on the film's DVD and is especially humbling. For instance, in the follow-up interview we learn that his medical malpractice rates increased 40% for the "settlement.")

In the end, we aren't quite sure if Dr. Flesher decides to return to medicine or not. You'll have to see the film to draw your own conclusion.

At times I felt the film leaned too heavily on the question of why doctors are unhappy at the expense of other critical health care issues. After all, not everything in medicine hinges upon whether doctors are unhappy or not, and that question is probably the least important to the public at large. Still, the issues of physician burnout and attrition, coupled with our ever-burgeoning health care bureaucracy and the loss of physician autonomy, will no doubt continue to affect the recruitment of future generations of physicians and perhaps the caliber of doctors in the future.

Nonetheless, both Dr. Flesher and Ms. Pando are to be congratulated for their bravery and fortitude at completing this documentary. It's a raw, unapologetic look behind the curtain of our current health care system from a physician's point of view. To my knowledge, this is the first time a doctor has used the creative venue of film to so vividly document the challenges we face.

Let's hope it's not the last.

-Wes

Disclaimer: I purchased the film for this review and have no conflicts of interest with the film team or production company.

Addendum: The film will be premiered in Chicago on 25 May 2010. Seating is limited.