Dying Of The Light

I read the letter incredulously.  The writer was a medical school administrator and had seen my poem published in The Annals Of Internal Medicine.  He was hoping I would send a few dozen signed reprints for him to share with the medical ethics class he taught at the local university.  I carefully fingered the paper and then threw it onto a pile of unsorted mail.  I felt a mixture of excitement and shame pulse through my body.  Somehow I knew that I would never send the reprints.  I would make up some lame excuse like I didn't have the time, or didn't want to spend the money on the prints.  But in reality, I knew the truth.  I felt a strange sense of awkwardness about acknowledging such naked praise. I hate making a spectacle of myself.

As a child, I remember trying to avoid the limelight.  Nothing made me more uncomfortable than my own birthday or graduation party.  Growing up in a large gregarious household, I felt best when I was observing from the corner, away from the spotlight. With the passage of time, I learned to raise my voice and assert myself.  Yet, I still felt shame discussing my own accomplishments.

Years later, I realize, that for a person with such qualities, becoming a physician was a perfect fit.  In what other field does one so naturally sublimate their own identity?  We seek not the praise of our accomplishments but the health of our patients.  At the beginning of our careers we take an oath not to forward our own personal needs but rather to do no harm.

Even in training, we learn the art of self abrogation.  We abandon our families to spend countless hours in the hospital for minimal wages in the service of humanity and the learning of tradition.  We donate our time and energies to staff free clinics and provide for those who are less fortunate.

And when we hang out our shingle and become engrossed in the business as well as the practice of medicine, the majority of us still feel a certain sense of humility.  We take a loss on various procedures because it is the right thing to do.  We write off our patients debt when they are too poor to pay their bills.  And it is a rare day that a truly needy patient is turned away at the door, despite the inconvenience it causes.

We imagine ourselves as servants regardless of society's point of view.

So it comes with little surprise that the heads of physicians are on the chopping block in today's health care reform climate.  Indeed, physician advocacy groups applauded the supreme court's recent decision to uphold the ACA even though it may well sound the death knell for the modern practitioner.  How indeed could the AMA or the ACP deny a plan that would bring health insurance to countless millions of uncovered lives.  It would be down right unphysician like.

Yet strangely, we require such a greater burden of proof for our own medical treatments in contrast to the sweeping changes that reform promises.  We accept accountable care organizations and patient centered medical homes without a shred of evidence that they are beneficial.  We defile the doctor-patient relationship and bastardize the residency training process because it's easier to accept than to stand up and advocate for ourselves. 

It is easier to let the nobility of our profession melt away than to call attention to our own needs.

The politicians and insurance companies don't have such qualms.  The pharmaceutical companies and leagues of government administrators don't face such psychic doubts.

We are witnessing the dying of the light.

And we have no one but ourselves to blame for it.