Blog | Monday, November 21, 2016

Lessons for organized medicine from the election


KevinMD reprinted a Medrants post – Will someone actually let actually help patients? This post has had wide reposting on Twitter and Facebook.

As we read and listen to “experts” dissect the Trump victory, one theme seems to emerge, the lack of respect for the working class. While many remain mystified with Trump's appeal, many opine that he convinced many that he heard them and understood them. An interesting op-ed in the Wall Street Journal, How Donald Trump Filled the Dignity Deficit, contains this paragraph:

“Too many Americans have lost pride in themselves. We sense dignity by creating value with our lives, through families, communities, and especially work. That is why American leaders so frequently talk about dignity in the context of labor. As Martin Luther King Jr. taught, ‘All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence.’ Conversely, nothing destroys dignity more than idleness and a sense of superfluousness—the feeling that one is simply not needed.”

Perhaps I am stretching a bit, but as I talk with physicians in private practice and academe, I too often hear despair. The New England Journal of Medicine has another article bemoaning the current state of medicine and medical training, Meaning and the Nature of Physicians' Work, that says:

“We believe that if meaning is to be restored, the changes needed are complex and will have to be made nationally, beginning with a dialogue that includes the people on medicine's front lines. Perhaps the greatest opportunity for improving our professional satisfaction in the short term lies in restoring our connections with one another. We could work on rebuilding our practices and physical spaces to promote the sorts of human connections that can sustain us—between physicians and patients, physicians and physicians, and physicians and nurses. We could get back to the bedside with patients, families, and nurses. We could get to know our colleagues from other specialties in shared lunchrooms or meeting spaces.”

For many physicians and trainees, we have lost much. We want to focus on patients, but (and use this term a bit sarcastically) “the elites” have imposed dysfunctional EHRs, performance measures, report cards and an inane payment system.

Patients want healthy interested physicians. Patients want us to connect. They want to feel that we care about them a people first, and disease second. We cannot measure this function, but we all know its importance. We physicians know the feeling when we hear the patient's concerns and address them to their satisfaction. We patients have the same feeling when we believe that our physician has our best interests at heart.

Since we cannot really measure these feelings, we have difficulty convincing the insurance companies and policy wonks, since they want measurables. There are things worth measuring in medicine, but just because we can measure them does not mean that the measurables define quality.

So I beseech myself and all other physicians to demand a change. These battles will not be won easily. ”The elites” do not really understand. But we have a moral obligation to let them know that the current regulatory environment hurts patients and physicians.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.