This summer I will have practiced medicine for 26 years. That’s just short of half of my life. I’m glad that I chose this profession. I have found great joy and satisfaction in my work. So, when young people ask me, ‘Do you think I should go into medicine?’ I almost always say ‘yes.’ After all, someone has to do it. If there are no physicians, who will care for us? For our children? Who will be there for our grandchildren? Neither diseases nor injuries will cease for the foreseeable future.
However, I always give caveats. There’s always a clause, a warning. Because there are some things about medicine that are unpleasant. And it’s incredibly unfair to send a young person off to medical school, residency and practice without some due caution. Realistic expectations are important.
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Medicine is hard. And sadly, it’s getting harder. What’s behind all of this? It’s probably far more complicated than anyone could address in 750 words in a column. But I think it comes down to the fact that we’ve made physicians, nurses and patients all into commodities of health-care corporations.
Physicians increasingly work as if we are making widgets on an assembly line. With the rare exception of the truly independent physician, not employed by a hospital or medical corporation, all of our times and behaviors are closely tracked and recorded.
How fast did we see the patient? How fast did we decide what to do with the patient? How fast did we give the medication? How fast did he/she get an inpatient bed? Were they all happy? Did they receive adequate and timely pain medication? Did we give too much pain medication? Did the patient or family have complaints or issues? Did the very sick patient have to come back to the hospital sooner than expected? (A thing that is no surprise but is financially penalized.)
Was everything documented for the sake of billing? Did we charge for the medicines, the food, the monitor, the IV, the IV medication, the blanket handed to the cold patient? Did we counsel about smoking and document the discussion… so that it could be billed?
Did we ask patients about every aspect of their lives, write it all onto the computer screen (the most important “customer” of all), and treat them appropriately? Did we enter that data quickly enough that we could immediately start on another?
Do we remember their names? Do we remember their complaints? As an aside, what was wrong with them after all? (That technicality seems to matter far less than the chart and the bill, things with lives all their own.)
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Were our charts completed in a timely manner, even if it meant staying an hour or two late?
We’ll need more tests. We’ll call you with the results; in a week or two. You really need more tests.
Here’s your hospital bill. Yes, it’s correct. You’re not in a participating plan, although your emergency didn’t realize that. We’ll need to collect more money than you make in a month. Today. Is that alright?’
At the end of the day the people taking care of the patients are in a tight spot. Even if they are paid well, they feel abused. Sometimes they aren’t allowed to have food or drink at their work-spaces, even as they have no scheduled breaks. In some hospitals, staff are tracked with RFID badges to demonstrate that they are where they need to be at all times.
Medicine, once the pursuit of individualists, once a profession of compassion and healing, is now a road of crushing student debt and soul-sucking rules and regulations where managers far outnumber clinicians.
And in the end, the people we hoped to treat become little more than numbers attached to invoices. And the educations and certificates we labored so hard to attain become tools of ironically named “health-care systems.”
I’m still incredibly proud of what I do. But I’m frustrated and saddened about what’s happening to my colleagues around the land. And by what has happened to the “customers, clients and consumers” we formerly called patients.
Dr. Edwin Leap is an emergency physician who lives in Tamassee with his wife and children. He is a columnist and blogger who covers a variety of topics. He is a nationally recognized thought-leader in medicine. You can contact him at firstname.lastname@example.org and follow his blog at www.edwinleap.com.