Wednesday, May 14, 2014

The Doctor Crisis

Every new adjustment is a crisis in self-esteem.

Eric Hoffer (1902-1983), The Ordeal of Change

We may well be in the midst of the most unsettling era in health care and that turbulence is bone-jarring to physicians. We argue that there is a doctor crisis in the United States today – a convergence of complex forces preventing primary care and specialty physicians from doing what they most want to do: Put their patients first at every step in the care process every time.

Jack Cochran, MD, and Charles Kenney, “The Doctor Crisis,”  The Health Care Blog,  may 13, 2014

Is there a doctor crisis today?

You bet there is.

As Jack Cochran, MD, executive director of Kaiser Permanente, and Charles Kenney, former Boston Globe editor, describe in their new book The Doctor Crisis and a blog by the same name, the crisis goes by different names.  Collectively the crisis might be called  The burnout-chaos-conflict-dysfunction-minefield-under assault  syndrome.

It is a crisis of self-esteem.  The authors ask: “How could there be a ‘crisis’ afflicting such highly-educated, well-compensated members of our society?” 

That’s easy.  If you are routinely and daily blamed for obstructing progress, for blocking innovation, for performing unnecessary tests, for acting in self-centered isolation, for suffering from societal tunnel vision,  for thinking of yourself rather than your patient,  you suffer delusions of self-worth.  You lose your self-esteem.

In their book, Cochran and Kenney define the ideal role of new physicians  as healers concerned for patients as person rather than themselves,  as leaders of health care teams,  and as partners with patients and others in the health care enterprise.  

Physicians are, as their Kaiser Permanente colleague states: “Skilled healers–no matter their specialty–take care of the person, not the problem. Orthopedic surgeons, for example, are not physicians for a body part. They are physicians for a person. This is complete care. It’s when physicians across the spectrum take the position that a healer’s role isn’t to heal a problem, it is to heal a person.”

Noble words these.  But it’s  not easy to fulfill this role or the other roles Cochran and Kenney describe. 

What if as a physician you choose to be independent,  to function outside of organizations such as Kaiser Permanente,  a large physician group, an Accountable Care organization reporting to the government,  or an integrated hospital system?  What if you decide to circumvent the burdens in time and money imposed by 3rd parties? These are important questions for independent physicians provide most of the care in America today,  not physicians in large integrated organizations.

What then?

Well, one option is to be a direct pay independent physician responsible to one’s self and one’s patient.   That way, you can “heal” the patient in a one-on-one person-to-person relationship.  You can still “partner” with other specialists, or other health care professionals outside your office, or with employers who want to send you patients.  You can be a “leader,” a director of your patient’s management.  And you can retain your self-esteem, by doing what your were trained to do – practice medicine with time to learn your patients' problems,  to  get to know them as persons- without being beholden to 3rd parties or your employers.  Your patient is your employer.

Tweet:  In the current turbulent health are scene,  a “doctor crisis” exists because doctors have lost their self-esteem  and time to spend with patients.

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