Blog | Friday, November 3, 2017

'Come fly with me'

It was my childhood dream to become an airline pilot. We lived near Heathrow airport in London, and I was a diligent plane spotter (please save the jokes). I had a book when I was nine years old that listed all civil aviation registrations, and I would mark them off as I spotted different planes through my binoculars, coming into land at the world's busiest international airport. My flying memories were on Pan-Am 747s, and my dad would arrange for me to go and meet the pilots when we were traveling somewhere. For any young boy, that's a dream come true. I remember the pilots were always so friendly and inspiring, patiently answering all of my schoolchild questions. These were of course, pre-9/11 days, and the world was a very different place. Pilots in those days would routinely walk the plane to meet passengers, and also do little de-tours if they ever wanted to show their passengers a particular sight!

My decision to pursue a medical career happened in my teenage years, and I must say I have absolutely no regrets in doing so. Despite the challenges we face in health care, many of which I regularly write about, I still find this an immensely rewarding career, where the positives outweigh the negatives.

And sticking with the theme of airline pilots and physicians, I've written previously about how what's happened to airline pilots over the last few decades, should act as a warning to physicians—you can read that article here. Sadly, airline pilots are a profession that has experienced a complete loss of autonomy and prestige, in the name of excessive corporatization.

An experience I had recently in New York City reinforced this feeling for me. I was walking on the sidewalk and a small car pulled up (it was probably a ride-sharing service). A pilot and co-pilot walked out. They looked jaded and tired (actually who knows where they had just come from, so don't want to judge them), but also quite scruffy and unkempt. They were wearing worn out shoes, got out of the car and plodded into the hotel, which didn't look like the nicest of hotels either! Oh, how different they looked from the image of the airline pilot that I grew up with, and the one portrayed in movies like Catch Me If You Can.

In that movie, in one of his roles as an airline pilot in the 1960s, Leonardo DiCaprio can be seen strolling the streets of New York and in various airports, surrounded by glamorous air hostesses, being treated with extreme respect by everyone he encountered. In one of the more famous scenes, he is walking while Frank Sinatra's Come Fly With Me is playing (a great movie for anybody who hasn't yet seen it). Of course, that was a caricature, but there is a serious underlying point here about what's happened to a profession that was once a very esteemed one. Part of this may have happened because we are all now flying a lot more, but part of it is also an accurate representation of what happens when any industry is corporatized.

Health care is ultimately about our patients, and delivering the best and most cost-effective care possible. At this time of great change in health care, that must remain our focus. We need to reduce costs and improve accessibility; there are far too many horror stories in our current system. The question is, how best to do this? I have also written previously about how, on so many levels, health care and big business are simply incompatible. This is for a multitude of reasons—including the fact that healthcare is a very unique arena unlike any other industry. While we may have some things we can learn from business principles and efficiencies, patients are not “things” on an assembly line, and hospitals are not car factories. In many ways, the days of the small practice independent doctor, served the needs of their patients much better. This was done at a local and personal level, which is what patients want. Whether or not having big corporations with multiple layers of bureaucracy, actually saves the system any money and improves care, remains to be seen (in fact, if we are talking about pure “customer service”, health care and doctors actually have a whole lot they can teach the airline industry too!).

Not so long ago, I was at a large furniture store in the Boston metro area. There was a “sleep clinic” area, where rows of customer service agents were lined up in white coats ready to advise shoppers on their sleep requirements in terms of bedding and pillow needs. I found the scene rather amusing, because these people were wearing white coats. But when I thought about it a bit more, I realized that this kind of scenario is probably exactly how many elements in corporate medicine would love to see physicians working. Lined up, with their shiny corporate logo, employed like any other “worker” for a large corporation who is telling them what to do, making sure they work hard to make the company and the executives a lot of money. What about all the medical school education, the crazy residency hours, and the dedication it took to get to where we are? Are physicians' destined to be reduced to widgets in a corporate system run by business folk, “Big Data” people, and administrators?

Hopefully there's still time to push back and keep our autonomy and professional prestige so that we aren't completely like the airline pilots.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site here.