Divided We Fall

The question that incessantly tugs at my gut is," when will we say 'enough'?" I have the good fortune to interact with physicians across our nation. What is stunning is the commonality of our experiences, frustrations, and fears. Nearly everyone echoes the same sentiments. We are downtrodden by the yoke of our loss of social and economic standing combined with an overdose of unnecessary and crippling logistical constraints.

Regarding the former, doctors have been subjected to an apparently intentional diminution of stature. Most obviously we are no longer "doctors"; instead, we are a mere segment of the blurred gamut called "healthcare practitioners". Within this array, physicians represent an oftentimes indistinguishable part. What happened to the time-honored concept of the doctor as the "general" with others in the medical field occupying the lower ranks along the hierarchy of expertise and concomitant responsibility? This militaristic construct was not born of abuse or cruelty to those below; it was a system created to guarantee that ultimate accountability lay in the hands of those most capable. And it ensured that physician extenders such as nurse practitioners and physician assistants -- excellent and integral deliverers of healthcare -- would always have the guidance and support of physicians, people with greater training and clinical expertise. More subtly, but equally disturbing, has been an erosion of hierarchy among doctors themselves. We have been commoditized. Our insurance-driven economic equalization has led to the notion that one cardiologist is as good as the next and every surgeon is equal to another. Of course we all know such a belief is absurd. Some surgeons tie knots around their colleagues; and superior cardiologists hear even the faintest of murmurs; while a few can barely hear anything at all.

As far as our logistical burdens go, we have become collared dogs, leashed and led by governmental, hospital, and even medical rules, regulations, and guidelines. Suffocating under piles of useless paperwork, fraying our fingertips on EHR keyboards, cautiously adhering to guideline-driven hospital-mandated algorithms, we painfully plod through work. Peppered into our otherwise bland and tedious days we occasionally experience the near-forgotten joy of practicing medicine.

To say that doctors are depressed, dejected, forlorn, hopeless, and despondent fails to do justice to the unfortunate cruelty that has hijacked our profession. Doctors are by nature exceptionally intelligent, diligent, independent-minded, inquisitive, creative, and caring. These characteristics are ill-suited for our changing world. Physicians never meant to work for others, yet over fifty percent of us now do. To grasp the impact of this single shift simply read the "professional satisfaction" surveys of practicing physicians -- they are not encouraging. We were not built to be handcuffed and forced to obey ill-conceived and oftentimes detrimental mandates. Doctors became doctors to acquire knowledge, integrate that knowledge into personalized and unique management plans, and by so doing help humanity and save lives. In addition, we always wanted to be recognized and appreciated for our work. Each of us sacrificed quite a lot to become what we are today. And these sacrifices were well worth it when we were permitted to recoup rewards -- social, personal, and yes, even economic. Now the rules have changed and we practice in an environment we had not bargained for. For many of us, modern medicine has become the antithesis of our dreams and aspirations. To some degree, we are to blame. We have relinquished the reins of our profession. We have allowed others to tell us how to practice, how to work, and even how to think.

Mistakenly, many believe that when doctors bemoan the state of American medicine we cry solely for ourselves. The truth is our tears fall for all Americans. We, the stewards of health, understand better than anyone else that the continuing changes in medical care are by and large for the worse. They deprive patients of quality in a vain attempt to augment quantity.

As I write this, I wonder whether it is too late. Can that which has been done be undone? Uncertain of the answer, I remain convinced that the only way to determine whether or not the decimation of American Medicine is reversible is for practicing doctors to come together in an attempt to stop the bleeding. For once we need to stand as one, speak with a singular voice of clarity and resolve and proclaim, "Enough".

Dr. Baum is a practicing preventive cardiologist with leadership roles in national and international organizations. These opinions are his alone. Read his blog at http://www.fpim.org/.

The question that incessantly tugs at my gut is," when will we say 'enough'?" I have the good fortune to interact with physicians across our nation. What is stunning is the commonality of our experiences, frustrations, and fears. Nearly everyone echoes the same sentiments. We are downtrodden by the yoke of our loss of social and economic standing combined with an overdose of unnecessary and crippling logistical constraints.

Regarding the former, doctors have been subjected to an apparently intentional diminution of stature. Most obviously we are no longer "doctors"; instead, we are a mere segment of the blurred gamut called "healthcare practitioners". Within this array, physicians represent an oftentimes indistinguishable part. What happened to the time-honored concept of the doctor as the "general" with others in the medical field occupying the lower ranks along the hierarchy of expertise and concomitant responsibility? This militaristic construct was not born of abuse or cruelty to those below; it was a system created to guarantee that ultimate accountability lay in the hands of those most capable. And it ensured that physician extenders such as nurse practitioners and physician assistants -- excellent and integral deliverers of healthcare -- would always have the guidance and support of physicians, people with greater training and clinical expertise. More subtly, but equally disturbing, has been an erosion of hierarchy among doctors themselves. We have been commoditized. Our insurance-driven economic equalization has led to the notion that one cardiologist is as good as the next and every surgeon is equal to another. Of course we all know such a belief is absurd. Some surgeons tie knots around their colleagues; and superior cardiologists hear even the faintest of murmurs; while a few can barely hear anything at all.

As far as our logistical burdens go, we have become collared dogs, leashed and led by governmental, hospital, and even medical rules, regulations, and guidelines. Suffocating under piles of useless paperwork, fraying our fingertips on EHR keyboards, cautiously adhering to guideline-driven hospital-mandated algorithms, we painfully plod through work. Peppered into our otherwise bland and tedious days we occasionally experience the near-forgotten joy of practicing medicine.

To say that doctors are depressed, dejected, forlorn, hopeless, and despondent fails to do justice to the unfortunate cruelty that has hijacked our profession. Doctors are by nature exceptionally intelligent, diligent, independent-minded, inquisitive, creative, and caring. These characteristics are ill-suited for our changing world. Physicians never meant to work for others, yet over fifty percent of us now do. To grasp the impact of this single shift simply read the "professional satisfaction" surveys of practicing physicians -- they are not encouraging. We were not built to be handcuffed and forced to obey ill-conceived and oftentimes detrimental mandates. Doctors became doctors to acquire knowledge, integrate that knowledge into personalized and unique management plans, and by so doing help humanity and save lives. In addition, we always wanted to be recognized and appreciated for our work. Each of us sacrificed quite a lot to become what we are today. And these sacrifices were well worth it when we were permitted to recoup rewards -- social, personal, and yes, even economic. Now the rules have changed and we practice in an environment we had not bargained for. For many of us, modern medicine has become the antithesis of our dreams and aspirations. To some degree, we are to blame. We have relinquished the reins of our profession. We have allowed others to tell us how to practice, how to work, and even how to think.

Mistakenly, many believe that when doctors bemoan the state of American medicine we cry solely for ourselves. The truth is our tears fall for all Americans. We, the stewards of health, understand better than anyone else that the continuing changes in medical care are by and large for the worse. They deprive patients of quality in a vain attempt to augment quantity.

As I write this, I wonder whether it is too late. Can that which has been done be undone? Uncertain of the answer, I remain convinced that the only way to determine whether or not the decimation of American Medicine is reversible is for practicing doctors to come together in an attempt to stop the bleeding. For once we need to stand as one, speak with a singular voice of clarity and resolve and proclaim, "Enough".

Dr. Baum is a practicing preventive cardiologist with leadership roles in national and international organizations. These opinions are his alone. Read his blog at http://www.fpim.org/.

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