Dear Prospective Physician:
I know there is a lot of talk lately about health care reform among politicians and pundits. The media throws around a lot of different vocabulary, some of which you are probably familiar with by now, including, but not limited to: single-payer system, socialized medicine, public-private partnership, government-run insurance plan, employer-provided benefits, co-insurance, co-pay, premiums, deductibles, pharmaceuticals, lobbyists, insurance companies, health-industrial complex, and pre-existing conditions. And which, of these terms, has anything at all to do with medicine–i.e. the treatment of human maladies? None. Absolutely none at all.
Our health care system–bogged down in meaningless terminology like the above–is completely divorced from the very basic needs that it is supposed to serve. These words function in an eerily similar manner as does military jargon. It puts a semantic fence between the professionals in the industry and laypeople, non-health care folk like me. Likewise, the military practices the art of verbal obfuscation regularly in order to avoid acknowledging that they are often responsible for murder. Call it “combat.” Call that nebulous dot on the ground you’re bombarding with missiles the “enemy.” Call the limp, bleeding bodies that will never return from overseas missions in one piece “casualties.” It’s much easier to conceal the horrors of war when you have words that completely distract from reality.
So, future M.D.s, let me make it completely real for you here: abandon your idealistic notions about medicine right now, if you expect to practice within the confines of our current health care regime. I want you to know what you are forced to become when you opt in to the system we have in this country. As a patient and a family member of someone who suffers from a slough of infirmities, I think you should understand a few things before embarking on your career.
Expect a new modus operandi. I am most unhappy to report that it is not the Hippocratic Oath, but the Oath of Benjamin… Franklin, that is. Unless you happen to be among a teeny percent of an already teeny percent of people who become blissfully sequestered research doctors, you will spend much of your time thinking about volume. Patients are commodities to be processed in numbers to pay off medical school loans.
Expect to become very appointment-conscious. And by that, I mean that you will learn to prioritize all appointments. If a pharmaceutical representative makes an appointment to “provide” you the crucial service of marketing material–free pens, clocks, post-its, informational boards with cleverly inserted drug advertisements, sample sizes of medications, stickers, clipboards, medical equipment–it is far more important than the patient who sits in the waiting room for 2 hours for an unanticipated emergency, hacking up a lung.
Expect to become far more efficient, to embrace the capitalist buzzword that has received such rave reviews in the business community. You will learn to size up patients in five minutes, and to eliminate all of the extraneous procedural crap, like asking a patient how he or she is feeling, how other doctors or specialists have treated a problem, or even using old-fashioned instruments like your hands or a stethoscope. Yeah, the lab coat and stethoscope are mostly accessories these days.
Expect to pick a pet specialty and hit the ground running with it, usually to the exclusion of other areas. Expect to become so immersed in that specialty that the rest of the human body–especially the ever elusive emotional dimension–has little or no relevance to your treatment plan. Expect to give up on helping a person when your treatment of choice fails to solve the problem. “Holistic” and “healing” will no longer be concepts you embrace.
Expect to prioritize your lunch hour or your vacation time over patient care. You will learn that the phone is your anathema, that returning frantic calls from patients is not really your responsibility, especially if you’re treating someone for any kind of mental illness.
Have these expectations, and you’ll succeed very well in our current health care system.
Sincerely,
Disgruntled member of the Inferior Patient Proletariat
Well I find myself torn by this post. On the one hand I agree with you almost completely, but as a soon to be pharmacist, and possible future M.D. (gotta see how the MCAT treats me) I also see the frustration and aggravation with all the possibilities for health care reform.
I agree that health care in this country is ridiculous and needs a major overhaul, but a significant portion needs to be patient education and personal responsibility. Do I think it is outrageous that so many people who go to work everyday to provide for themselves, their families and pay their taxes can not afford health care, absolutely. Do I get increasingly annoyed when medicaid patients go to the ER for head colds instead of getting a primary care physician, oh it makes me want to scream bloody murder.
The first needs to be the cessation of the abuse of this system before we attempt to “fix” it.
…and now I shall collapse my slightly smaller soap box from in front of yours. Thank you.
Hey Leah,
It’s true, much of the talk about health care addresses nothing but the esoteric business jargon that has—especially at these “town hall meetings”—become food slop in a cafeteria. What most people don’t talk much about—regardless of their stance on the proposed changes—is the interface between business and practice. Few are the discourses that address salaried pay, physician ownership of hospitals, and accountability. The surface of the health care problem, though chipped, has maintained its integrity largely due to desultory and disunited arguments of business (as you rightly point out) and health alone (which unfortunately take the form of mere complaints).
That said, there is a cynicism here towards the future of the health care industry that I’m not sure is entirely fair, one that leaves doctors as scapegoats. And yes, many doctors feed into the cycle; some are as much to blame for their corporate greed as are insurance and pharmaceutical companies. But I find this letter (or at least its fatalism) to be slightly more relevant to doctors who entered the force 5, or 50, years ago. That is to say, I think things are about to get—at the very least—less bad.
Part of this is because the discourse on health care is indeed expanding (slowly…), because doctors have found themselves in a glaring spotlight and don’t want to be labeled as scapegoats (many aren’t), because there were fewer structures to encourage a more efficient medical “community” before Obama took a bellows to the debate. I do believe that to some extent we will see the medical establishment consider and adopt some of the proposals that are currently viewed as ancillary to the overarching problems of health care litigation. These ancillaries include coordination and digitization of care records and procedural process, focus on preventative medicine, and other options that will make it harder for the “bad doctors” to hide behind a veneer of lone Hippocratism, and easier for those “good doctors” who embrace a cooperative change to connect to a cause, reduce the damage done (economically and physically) by unnecessary care and procedures, and reinforce the care they can individually and collectively offer.
That said, what sounds like idealism here is in large part counterbalance; I do check myself quite often, and I frequently feel very, very cautious about my optimism.
A last, smaller point about “pet specialties.” As “Ash” hints at above, these aren’t the front lines of health care. Perhaps you’re criticizing a certain type of specialty, but don’t you think that some doctors should be hypercompetent in one particular area? Sure, even a specialty involves a knowledge of relevant systems—a neurologist being familiar with the physical implications of certain motor/muscle complexes, for example—but I don’t see how holistic medicine is able to function far past GP and emergency medicine. The latter I’m seriously considering, in fact, though most serious cases will be primarily performed and overseen by a specialist—someone who performs hundreds of a certain procedure a year, and likely with a better success rate than a “holistic” peer. Here, there’s a conflation of honed skill and physicians’ narrowmindedness, emotional stupidity, and perhaps a collection of unsavory experiences you’ve had with doctors. I’m not sure how much of that is sarcasm.
All that said, I really enjoy reading through these!
-M
Hi, Michael! Thanks for reading–and for your valuable comments.
Much of this was rhetorical flourish, written in a moment of painful frustration with the health care system. This post was not really meant to blame doctors. Rather, I meant to highlight the symptoms of a seriously flawed system, one with which future M.D.s may be doomed to grapple. This system affects the level of care and the kind of talent that the medical profession attracts. Everything you say about giving doctors salaries, giving them more say in hospital management, etc. are all elements of a sound policy. Unfortunately, that’s not what we’ve got, and because we’re in a system that is volume-based rather than results-based, there are a lot of unsavory practices in the medical profession. I don’t know that we’re going to see any fundamental reform on that front, given the level to which our “debate” on health care has sunk.
Also, I think what I meant by the “specialties” comment is not to disparage specialization. My health has been enhanced by many professionals who are specialists in their field–dermatologists, gynecologists, opthamologists, etc. What I meant by that remark is that 1) under our current system, there is very little coordination in care between the system of doctors any individual sees and 2) there are not enough general practitioners/internists, a problem that has been widely identified. I don’t mean to suggest that you shouldn’t see an eye doctor if you have an eye problem. That would be absurd!
I think we probably agree on most points. I’m just a little more cynical about where we’re going.
Also, I think I forgot to include this incredibly overlooked word, but: incentivisation!