Friday, December 5, 2014
Doctor, do you suffer from Glory Day Syndrome?
The practice of medicine is changing faster than anyone can keep pace with. As a hospital physician at a relatively early stage of my career, I'd say that a sizable number of physicians that I work with are towards the latter end of the spectrum. I find that these doctors, typically over the age of 50, are struggling the most to keep up with the changes occurring around them.
I have the greatest respect and admiration for these colleagues and always learn a lot from them on a daily basis. I feel their pain as they talk to me about issues such as increasing bureaucratic barriers between them and their patients, the encroachment of information technology on patient time, and the inability to thrive as small practices. But I've also noticed another trend among some of these doctors—who represent all medical and surgical specialties. And that's a tendency to exhibit symptoms of “Glory Day Syndrome”.
Let me digress for a moment and explain what I mean by this. One of my favorite new authors is a gentleman named Chris Guillebeau. For those of you who don't know him, he's an Oregon-based author and entrepreneur who has written 2 New York Times bestselling books over the last few years. He dedicates a lot of his time to public service and one of his personal goals was to visit every country in the world before his 35th birthday, which he achieved in 2013 (that's 193 countries and for those of you who are wondering; this was done on a shoestring budget).
In his first bestseller, The Art of Non-Conformity, he wrote an excellent chapter based on the phenomenon of Glory Day Syndrome. He recalled a time when he was listening to a speech in which the speaker was recounting an experience from his youth. The person was describing in vivid detail the events from decades ago, as if they had happened yesterday. The speaker was clearly proud of what he was talking about and all of his past achievements. Guillebeau then went on to write about those “Glory Days”, which all of us have to some extent. They are foundational experiences which shape us and represent a time in our life when we felt a great sense of personal growth and attainment. They could be our university days, a sporting achievement, early career success, or a time when we met someone very special.
But the statement that came next from Guillebeau was very profound: Glory Days are dangerous. They are dangerous because as soon as we get into a situation where we are thinking too much about the good old days and yearning for them again, it means that we are assuming that the best is behind us, that we cannot ever have those days again. But this should never be the case, because if those days were as good as we think, why can't we draw on what made them so wonderful, build on those lessons and make the future even better? It's not about forgetting about the good times and stopping to remember them fondly. Far from it, we couldn't forget them even if we tried. We are rightly proud of our Glory Days and what we accomplished. But neither can we get stuck on them for too long.
How does this relate to health care and what I was talking about a couple of paragraphs above? Well, I see many late career physicians who talk a lot about the “good old days of medicine”. The days when physicians enjoyed autonomy, patients felt close to their doctors, and there was much less bureaucratic control. All very valid points. These doctors are nostalgic about those Glory Days when they savored the practice of medicine a lot more than they do now. Never mind the fact that if the older generation wants to look at the current state of affairs with dismay. They only have their own generation to partly blame for “losing” those days and getting to where they are now.
Harking back too much in life can never be a good thing. As an optimist I don't believe that the glory days for doctors and the practice of medicine are necessarily behind us. Looking on the bright side, the medical world is developing amazing new treatments and cures unthinkable a generation ago, people are living longer, and the philosophy of patient-centered care is the right way forward. We are making great strides in patient safety and lowering the length of time that people spend sick in hospitals.
The not so good side: More bureaucracy, administration requirements, concern about falling reimbursements, health care information technology as it currently exists is a pain, and career burnout is increasing. However, surely these are things that together physicians can all work on to reverse and make better? The pendulum can easily be swung back (much harder things have been done before) with the right organization and vision. With all of the scientific and technological discoveries around the corner, a golden age of medicine is on our doorstep. The question is, what role will doctors play in this? Keeping a focus on patients, practicing good medicine in this time of rapid medical advancements, and keeping the doctor-patient relationship at the front and center of all healthcare. Surely the Glory Days must still lie in front of us.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
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