Monday, August 31, 2015

If We Fight For It

It occurred to me towards the end of our conversation that there was a large gaping hole.  We had talked about physician burnout, career choices, and his current plans.  He had drawn a map of his future.   It originally shot like a straight arrow towards clinical medicine, but now veered precipitously.  I took a moment to first clear my thoughts, and then my throat.

Medicine, I explained, is still as noble a profession as ever.  Every day I dip my toes tentatively into the current that swirls around me.  Often I am pulled violently into the depths.  My body bumps and sways in the mass of humanity.  Our rhythms join at times and depart at others.  Amongst the tumult my mind strains to unlock riddles, my hands reach forward pawing the Rubix Cube of disjointed anatomy laid bare on my table.

I am imperfect, and it is hard.  Maddening.  I sometimes curse my own feeble abilities.  Yet this profession offers the opportunity to be with our fellow humans.   Regardless of outcome.  It offers the ability to reach an imperfect hand towards a suffering soul.  Over and over again.  On weekends, on holidays, in the middle of the night.  When it's inconvenient.  When it really matters.

You become the beacon of light to someone's darkness.  The epitome of meaning, wrapped in a profession, crafted over years of practice.

There is nothing that I would rather due for a lifetime.  No profession more worthy.  No pastime more challenging.  No calling more sacred.

We suffer today not from a failure of training nor a mighty profession gone astray, but from the greedy, lecherous, and diabolical distortion foisted upon us,

We suffer from a government so mired in special interests that often the most simplified and logical tasks become overly burdensome.  Administrators with little knowledge of actual medical practice add layers of bureaucratic minutia on the backs of hapless workers.  Computer systems are generated with the wrongheaded idea of Big Data collection as they further warp severely strained processes.

We suffer from big business, hospitals, and insurers bent on squeezing every last cent from a system where they produce nothing.  They repackage the knowledge and ability of their clinicians, and slap a brand new inflated price tag.

And we suffer from ourselves. Our medical societies who pat our back with one hand while picking our pockets with the other.  Our physicians who have lost their way, and traded in this holy art for a chance to feast on the leftovers from the carcass of their debilitated brethren.  

The doctors who value bloat, cruelty, over-testing, and over-diagnosis to add to their wealth and not the health of their patients.

Medicine can still be noble and worthy.

If society allows it.

If we fight for it.

8 comments:

DrWes said...

Jordan-

Like you, I love the profession but am deeply crushed by what it has become. Special interests increasingly control the dialog, but doctor are slowly stirring. I can only hope practicing physicians have enough backbone to restore the sanctity of the doctor patient relationship before I get too old and fall prey to the vultures within our own bureaucratic physician ranks that are picking clean medicine's soul for their own largess.

Jaime M Thomas said...

Thanks for the post Jordan. I wonder if the conversation you are talking about was ours. The questions for me still lingers. What can we do as patients, as a society, to foster the noble and worthy practice of medicine? I can at least say that we are trying at FulfilledPhysicians.com. Thanks for the great work you do.

Anonymous said...

Great piece of writing. Like all physicians, I feel your pain. I agree with Dr. Wes that doctors are stirring. Unfortunately, it is too late. Most physicians now are employed by large healthcare corporations, that will not acquiesce to our demands unless we form a union or other collective bargaining entity, which physicians are loathe to do. I think some of the independents who are left, who are forming various direct pay practices, may stand a better chance. But these practices are likely to be successful mainly in very large cities, and mainly in primary care. For the rest of us, things are just going to get worse.

Anonymous said...

RE Is Medicine wasting away or just suffering another "turn of the wheel?"

Look to Arrowsmith by Sinclair Lewis.
We are on the inevitable track of a new cycle.

I am more confident than ever that the "new generation" will NOT lie down forever.

Computerization (ie EMRs) may have been the trigger but the computer is a tool that helps me every day to do better care for my patients.

I am NOT saying it is not extremely dissatisfying to live through this transition, but I am hopeful.

Dr Matt Levin
Western PA
matlev@comcast.net
11 years in solo independent practice.
30 years out of medical school.
27 years out of family medicine residency.

Anonymous said...

So truthful in so many ways.... I have walked away from medicine for those very reasons. I almost lost my life to it. I lost my marriage. I've lost my self esteem and my health ironically. I never thought going into medicine would be the worst choice of my life.....

Nora Proops said...

I am a medical student with four days left before applying to residency. I entered school with hope, purpose, and faith in humanity. It is certainly not lost, but definitely has been tested even in the beginning stages of this long training process. As I read reflections from seasoned physicians, I am looking for my hope to be rekindled. I need to believe that this profession is worth the sacrifice. And so, you have left us with the message that we need to fight for the noble profession we still hold in our hearts. We (I say this generously, as I am not yet a physician) need to fight for it and not continue to be mere players in this system dictated to us by those driven by data and money and those who do not speak to patients on a daily basis.

The next question we need to pose is: HOW do we fight for it????

Nora Proops said...

I am a medical student with four days left before applying to residency.

I entered school with hope, purpose, and faith in humanity. It is certainly not lost, but definitely has been tested even in the beginning stages of this long training process. As I read reflections from seasoned physicians, I am looking for my hope to be rekindled. I need to believe that this profession is worth the sacrifice. And so, you have left us with the message that we need to fight for the noble profession we still hold in our hearts. We (I say this generously, as I am not yet a physician) need to fight for it and not continue to be mere players in this system dictated to us by those driven by data and money and those who do not speak to patients on a daily basis.

The next question we need to pose is: HOW do we fight for it????

Anonymous said...

All over the world, skilled professionals have been(and are being) degraded, disrespected, and underpaid for their hard won skills, their imaginations, and their advances in so many areas. Not only in direct patient care, but in other professions, such as engineering, chemistry, and public health each individual has become seen as a commodity (homoginized) so much: No individual's special qualities, work ethic, morals, or other aspects of each one of us is suppressed.

Is 'Big Data' alone to blame? Or are the now more highly regarded Administrators, middle managers, and other faceless bureaucrats afraid of making decisions based on personal characteristics of others without 'computer-based' support.

Certainly, in today's world, Bill Gates, Micheal Dell, Steve Jobs, Jack Kilby, the Wright Brothers, and many others I could name wouldn't be even considered for a 'corporate' position-And 'Too Big To Fail' businesses and of course the Monsterous Governments roll over talented individuals with ideas or processes which might threaten the 'Status Quo.' As an engineer, before medical school, many of my ideas were quashed by this phrase, "We've never done this," or the non-medical phrase, "NIH"
which meant, "Not Invented Here."

In medicine, I use the 'Jack Kilby' approach, also mentioned by the late Amos Tversky and his Nobel Prize Winning partner, Daniel Kahnemann, and Naseem Nicholas Taleb. I look at patients as individuals yesterday, today, and tomorrow-I acknowledge each individual possesses many facets-the medical, emotional, social, and others. To use a
paradigm mentioned by the Greek Philosopher, Heraclitus: "You cannot step into the same river twice." This was corrected by the German Physicist Werner Heisenberg: "You cannot step into the same river once!" Why? Because stepping into the river changes the river. My patients change over time, a factor not under the contol of bedside caregivers, with interventions including just walking by their doorway, smiling, and saying, "Hello" or not doing so. Jack Kilby recognized he was educated and worked as an EE(Electrical Engineer). Yet, he defined a goal, sought all the information he thought could help him reach his goal, and decided he would function as a magnifying or focusing lens to real his goal-He created the first IC(or integrated circuit) for which he received a Nobel Prize.

We physicians, to become more respected, must as you say, must become more forceful in showing others we aren't 'cookie cutter providers' as many consider us. Our professional organizations have leaders who no longer practice at the bedside, even those in Academia. All too many have MBA or MPH degrees both leading to considering patients as groups and not as individuals-Dr. Atul Gawande wondered why CheeseCake Factory has better quality control than medicine does! Really? CheeseCake Factory strives to produce the same product each time, in each location. It has contol over each factor involved in their 'product.' Patients are NOT the same-We have NO CONTROL over their charteristics before, after, and during their health care-No 2 patients, and no patient over time, etc. is identical-We should look at the philosphy or intent of Guidelines, not at their dictates->In a moment of acknowledgement, Dr. Gawande, in his book "Better" when discussing the 'Best CF clinic in the US(Fairview-University Childrens' Hospital, MN)' quotes the then leader on guidelines(see pages 217-230) on guidelines. Dr. Gawande then mentions 'average' outcomes and 'settling' for it. In that CF clinic, patients are treated as individuals, treatments are developed by using general pathophysiologic principles AND COMMONSENSE MEDICAL REASONING, not from studies which are 'multi-hospitals, randomized, and blinded.'

This is too much for now, I apologize. Summary: I agree with 'If We Fight For It."