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Self Care Line

Self Care Line

I do not usually write about religion or politics, certainly not from an authoritative perspective. Both are great topics of debate, but it takes a great amount of fortitude to approach each subject with the proper mix of subjective and objective thought as well as worldly experience. I have found that those who are committed extremists cannot caucus with anyone other than other committed extremists of like mind. Most of our worldviews are shaped and formed by our family of origin. Our challenge is to take what we have been indoctrinated with, project it into the world and if the world spits back at us with dissention, we are to adjust our worldview accordingly.

Over the past few months, I have noticed a distinct difference in patient attitudes toward the medical industry all together. I think it started with the idea of health care reform. The American public has been upset with the medical industry as a whole for at least fifteen years, but prior to the new federal legislation I believe the majority of Americans were dissatisfied mostly with the expense side. The costs of care were rising faster than the flood tides of a hurricane. Thus an act of federal legislation was introduced to curb the rise in costs of medical care in general. However the quality of care was of no concern and not addressed in the legislation.

There is no question that Americans believe that we have the best healthcare system in the world. That is one of those American worldview things that greatly disturbs me as a physician working in the trenches. In my practice, I have witnessed some of the poorest quality care provided to our patient population anyone could imagine. I am not sure whether to blame the healthcare system or to blame the physicians who believe they are in charge of the system or both.

No one is immune from the lack of quality care. When I was in my Emergency Medicine Residency in Cincinnati, Ohio during the middle eighties, I had a conversation with Richard Levy, MD, Chairman of our Department. He was a very savvy Chairman. He pulled me aside one afternoon after I worked a twelve hour shift and spoke to me:

Kevin. You'll not last in medicine. You care too much. You've got this idea. All of us are like you. You're a great diagnostician. You know your stuff. We aren't you. I predict you'll get out within five years. You just can't handle working with mediocrity. The majority of us are mediocre at best. You're a perfectionist. We aren't. The system is failing. I'm not sure what you'll do. It's probably not medicine.

I listened to him because he was an authority figure. I respected his objective assessments of life events. He was a less-than-mediocre physician, but an expert at reading people and behaviors. Fortunately he worked very few shifts in the emergency department and spent most of his time fighting off the wolves in the academic world. He was correct about one thing, I certainly was different than my colleagues. I did not know it at that time, but I was very different.

Over time, from my perch slightly above the fray of the delivery of medical care, I recognize that no one physician is in charge of a patient's medical care. Patient care is fragmented. What is even more apparent is that each physician who has been qualified as a specialist, seems to have the opinion that they (and only they) have the exclusive definitive knowledge in their field of medicine. Anyone can pick up a medical journal or search the internet and find the same information that they believe they have exclusivity to. In addition, they have no knowledge of anything in medicine other than their narrow field of qualification or at least they share that construct with their patients when they are asked to expound on something outside of their field of expertise.

Specialist proudly speak about being consultants, which in the classic sense are people who are supposed to give advice about the potential care options for a patient. Consultants rarely take responsibility for their advice, it's viewed as merely advice to the physician who requested the consultation. However, most primary physicians just incorporate the consultant's view directly into their patient's therapeutic adventure, rarely giving second thought to what untoward side effects their advice might have on the patient's overall condition. To be an effective primary care physician, one must know as much or more about a specific medical condition as the specialist themselves. The idea about consulting is to get a fresh view from another set of eyes, not turn over care to a physician who is too busy to tie their own shoes.

Some specialties have expanded their scope of practice such as hematology and oncology. That specialty is rapidly changing. They have their own set of jargon and tend to advise patients from a very narrow window. It takes a lot of time to educate oneself on the current or up-to-date information in the field because of all the clinical trials and new therapeutic options for treatment that are ongoing. It is big business. Any patient who has been diagnosed with cancer should take a few days to research their disease on the internet, find the full scope of treatment options available and make an appointment with their primary physician to discuss the pros and cons of the therapy that the oncologist has recommended. I know I live in a dream world because this kind of patient-doctor behavior rarely, if ever, happens. Very few primary physicians want to take the time to discuss treatment options with cancer victims, they prefer to let the "other guy" handle it.

As patients are passed around from specialist to specialist, they become more frustrated over their care. Most feel like their playing a game of hot potato, and they are the potato. Yesterday, I briefly examined a woman with a number of complaints who had been to every specialist in the city, tried multiple medications and was on the verge of losing her job because no one could find any relief for her mysterious disease. She has tests ordered by specialists who were clearly grasping at straws, doing tests for the sake of doing tests. She was miserable. No one could give her the slightest answer. The collective mind of these physicians had lead to nowhere but confusion. I'm sure we'll figure something out, or at least stop the madness of multiple visits to multiple specialists who have nothing to offer.

Yesterday, I also saw a woman who had an undiagnosed illness and had made two trips to Mayo Clinic. Each time their physicians told her she had something wrong, but it was a mystery disease so she just had to suffer through it. Mayo's physicians had no therapeutic recommendations. She would have been better off buying two pieces of my art. She saw plenty of specialists, but no one could put the pieces of her puzzle together either. Perhaps the slogan, forget Mayo, go to Merigian should be shopped around the internet.

If there is a call for reform, let's start by making sure the brightest, most creative physicians are compensated the highest for diagnosing the undiagnosed and treating the untreatable. What our system lacks is a cohesive collective of creative diagnosis and treatment. We have to open our eyes to the failed antiquated ideas and models of medicine that were established in the 1920's, and begin new approaches to diagnosis and treatment. Forget the fancy machines that image every part of a person's body, knowing that a sick patient's anatomy is normal does nothing to uncover the dysfunction that they are going through.

And let's stop trying to relabel excellent general comprehensive medical care as: alternative medicine, complementary medicine, functional medicine, orthomolecular medicine, holistic medicine, mind, body, spirit medicine, new age medicine, etc. Why not embrace the term general medicine and devote ourselves to improving the quality of care?

The cost of medical care is still rising. The Affordable Care Act reduced the slope of increase, but every element of the industrial medical machine is charging more and profiting more with two exceptions: physicians and nurses. They're on the losing end of the deal. Without a strong physician voice for change, not one that is focused on greed, avarice or profit margins, doctors are going to be reduced to nothing more than underpaid service providers, much a kin to the old gas station attendants. And what patients want are accurate diagnoses to their healthcare problems and treatments that are effective and cost appropriate; prescribed by a compassionate physician regardless of their qualifications or certifications.

The only other alternative I see in the future will be the creation of a self-serve healthcare line. It's happened in every other industry in America, why not in the practice of medicine?

If ignorance is bliss, tis folly to be wise.

Doc
Posted by Amanda Sanders at 9:57 AM
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