you really should watch this

 

Last weekend, I was speaking to a friend of mine who is thinking about retiring from medical practice, not because he can no longer keep up with the demands of patient care or the new technology. Not because of ill-health, or exhaustion, or forgetfulness. The problem is a health care system that subscribes...indeed, surrenders...to the demand for power, speed, and profit at the expense of excellence, compassion, and human connection.

"America's health care system

is neither healthy, caring, nor a system."

~Walter Cronkite~

Back when I started out in medicine, in the early 1970s, the problem was oppressive paperwork. Now-a-days it's an oppositional defiant electronic medical record. A baffling coding and reimbursement system. The ever-present threat of litigation. A pharmaceutical industry that invests as heavily in marketing as it does in service. A health insurance industry whose number one priority is corporate profit, not compassionate care. 

My friend feels he has no choice but to retire.

"You can quit your job,

but you can't quit your calling."

~Lissa Rankin~

Reflecting on his predicament, I put a series of rhetorical questions to him:

• What happened to the drive for excellence in patient care?
• What does that excellence embody?
• When did our priorities as providers shift in favor of speed, power, and profit?
• Is it possible to restore the sanctity of the doctor-patient relationship?
• Is there any time or space for compassion, communication, and connection in patient care?

He met my gaze with a blank stare.

Then I remembered a TED Talk by Abraham Verghese, titled "A Doctor's Touch." You can view it here:

https://www.ted.com/talks/abraham_verghese_a_doctor_s_touch

 Don't get me started...

In this video, he discusses the laying on of hands by the physician...the importance of touch in patient care. He reminds us that modern medicine is in danger of losing this powerful diagnostic and therapeutic tool because, in today's health care system, patients have been reduced to mere data points. He calls for a return to the traditional one-on-one physical exam. This belies the glorification of the 10 minute office visit, the game of "Beat the Clock" doctors have to play in order to meet productivity quotients. In order to generate income.

These trends in the practice of "modern" medicine, among others, are what led me to bow out of medical practice when I did. I retired out of fear of the inevitable: that someday a patient of mine would suffer or die because there simply wasn't time for me to do my job well. It has happened. 

It happened to the patient who was admitted through the emergency room with a diagnosis of acute appendicitis when the ER doc, in his haste, missed the pulsating mass in her right lower quadrant that would have clued him in to the dissecting aortic aneurysm that brought her in that night.

It happened to the eighteen year-old who died of complications of sub-bacterial endocarditis that was missed because it can be hard to palpate an enlarged spleen or to hear a soft heart murmur when you're in a hurry.

It almost happened to the woman in the ER who claimed to have sustained a injury to her right eye when she tripped and fell against the corner of her nightstand...when in truth, a blow from her muscle-bound boyfriend's clenched fist had caused a fracture of the orbit that required urgent surgical intervention. Try teasing that out of an EMR. It also meant we had to notify law enforcement, and social services to secure safe shelter for her when she recovered...if she recovered. None of which could be rushed.

These are all true stories. 

Thankfully, there are physicians like Abraham Verghese who are willing to speak up while the rest of us struggle to collect our thoughts. How did this happen? Who is in charge here? Is there any hope for us? We are defeated by our failure to act on what we know to be true. Discouraged from exercising our deepest intuition and hard-earned wisdom. Defeated by a system that is on the wrong trajectory and doesn't grasp the problem.

"We touch heaven when we lay our hands

on a human body."

~Novalis~

Next, we need to tackle the absence of eye contact with our patients.

jan