"Fear and Hope on the Medical Staff" - by David Hyman
My client’s son is on the cusp of medical school. He is a bright young man with a curious, analytical mind and the idealistic verve that such people have when beginning a career. Medicine claimed him when he was small. After all, his father is a wonderful, smart physician, so he’s been around it forever and has seen its wonders. But my client fears that the profession he entered thirty years ago — the one that his son anticipates — is eroding into a flatland of dedicated but frustrated, exhausted physicians caught in a soul-grinding system. He frets that his beloved profession is changing so much for the worse that his son will never have the opportunity to care for patients as he has always strived to do.
The grinding of the system is evident. Almost weekly, something appears in a major journal decrying the state of the profession, complete with examples of dedicated doctors flaming out. Only last week the Wall Street Journal ran an item by a metropolitan endocrinologist describing his untenable life of managing patient demands, a maddening EMR system and its irrational “meaningful use” requirements, a herculean patient load, ever longer hours needed to complete preauthorizations, drug formulary searches and correspondence. In all, his professional burdens were devouring his mornings, his evenings and his weekends in addition to his ordinary clinical hours. What’s more, this week’s Modern Healthcare reported another survey showing that, for the same reasons, a third of U.S. physicians are “quickening their plans to retire”.
My client seems equally taxed. He has forever given a full measure of himself in his practice. But I see that his sense of professional responsibility may no longer be equal to what confronts him. Though he arrives early and stays very late each weekday and is in his office both days of most weekends, he is hard-pressed to read and interpret all the labs, design all the care plans, chart all the minutia into the EMR system, communicate with referring physicians and patients, insurance companies and pharmacies, and prepare for upcoming patients. The longer this goes on, the more weary he becomes; he fears that this will diminish his professional ability. I asked him why it all takes so long — it didn’t seem to a few years ago — are they paying you for an eighty-hour week? His reply both echoes and illuminates the problem. The tasks are far more onerous and exhausting than ever, electronic charting and record-keeping is more tedious and endless than ever, there aren’t enough support people so ever more routine tasks fall to the physician, patients’ expectations are frequently excessive and unreasonable, and the compulsion to see ever more patients is Sisyphean. It’s seems more of an industrial process than a profession.
Like those physicians in the news, my client thinks something has to give and he does not want it to be himself or his patients’ wellbeing. He fears that it will unless good physicians reassert their ideas for good medical practice. He fears it for himself, and he fears it even more for the bright, enthusiastic future physicians like his son. Fortunately, he and many other dedicated physicians have some clear, reasonable ideas about what to do. I hope they aren’t too weary to share them. And I hope someone listens.
By David J. Hyman, firstname.lastname@example.org
Originally published in the October 2014 edition of Tulsa Medicine. www.tcmsok.org