Friday, March 4, 2016
This is why pushing for change is tough for physicians
Physicians are an interesting and eclectic bunch of people who have sacrificed a lot to get to where they are. Just getting into medical school alone is an academic achievement to be proud of. And that's just the start of the journey. What follows is one of the most rigorous courses of study in existence. Test after test, exam after exam. And when you're finally done with medical school and have earned the right to be called “doctor” (often a childhood dream)—you find yourself at the bottom of yet another career ladder as you slog your way through residency! Going through such an intense process means that most doctors are by their nature incredibly hardworking, mentally tough, independent-natured and freethinking.
We are of course also at a time in health care when all physicians, no matter what our specialty, are feeling the full force of change in almost everything we do. Some of these things are great, others not so much—for our patients too.
Over the last several months I've written about a number of issues that are pertinent to the practice of frontline medicine. These range from how we can improve patient satisfaction and the health care experience, suboptimal information technology systems, to more subtle changes in the way that physicians work and are perceived by their counterparts and society at large. The response to these articles has been highly interesting to observe, and underscores a wider phenomenon in how physicians in particular, as opposed to many other professions, think and organize themselves.
Take for instance a series of articles expressing dismay at the fact that physicians are no longer being addressed by their true job title, but by the word ”provider“ instead. This culminated in an open letter to the American Medical Association and all State Medical Boards that was widely circulated online. The response to this letter ranged from full-fledged support, to almost as many comments and responses from physicians dismissing the idea—instead trying to divert attention to “more pressing” matters.
Then there's the issue of healthcare information technology. If you were to ask any frontline physician (or nurse) almost anywhere in the United States, what their biggest daily frustrations are, health care IT will be at or near top of the list. Clearly there's a problem that needs to be addressed. However, several articles that have sought to bring attention to this, written by many other colleagues too, have been met with a shrug of the shoulders. They have attracted comments from physicians along the lines of; “It's never going to change, so stop talking about it” and “Discussing this is laughable”. Worse still, they often border on personal attacks on the author. I'm all for open discussion and am quite thick skinned, but it's sad when we reduce ourselves to this level, especially when there's probable large-scale agreement on most points.
Perhaps the internet as a whole is more adept at giving a platform to the voices of the cynics and pessimists, neglecting the silent majority. When browsing through the comments sections of articles from a wide variety of different perspectives, some of the more bizarre opinions expressed are from supposedly experienced doctors who, quite frankly, should know better. The article on being called a “provider” was rejected by some physicians for being “last on the list of concerns compared to other problems”. While there is no doubt that other such pressing matters may indeed be very pertinent and higher in priority, an issue such as being called a “provider” is a highly symbolic one, which is actually very low hanging fruit to change.
In real-life realms too, when discussing any problems that health care is facing, my experience has been that as exceptionally intelligent and often times refreshingly rebellious individuals, physicians don't align themselves easily with any given cause without picking holes in an argument and highlighting other unrelated problems. This is not necessarily an advantageous thing to do when it comes to getting things done.
With any agenda or argument that may have broad support, wherever and whoever it comes from, physicians would do well to remember 3 golden rules of affecting any kind of positive change. Firstly, change happens in small steps. Rome wasn't built in a day, and neither will moving healthcare in a better direction happen overnight. Secondly, on any particular issue—never, ever make the perfect the enemy of the good. Even a tiny change in the right direction is better than no change at all. And thirdly, when you are seeking consensus and allies for your cause, someone who is 90% your friend is not 10% your enemy.
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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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
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.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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David Katz, MD
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Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
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Other blogs of note:
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
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The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.