Medicine at the Crossroads

 

        “When you look for the bad in mankind expecting to find it, you surely will.”    Pollyanna

 

I try not to spend too much time on Facebook, but it’s always been a good way to keep up with “friends” in the Scottish Deerhound world.  The deerhound, being a rare breed, tends to link people across the country, and indeed the world, who have similar interests.  Lately though, the deerhound people haven’t been discussing dogs much.  Instead, they’ve been discussing their terrible experiences with the world of medicine.  One owner described being admitted through the emergency room of her local hospital for stroke-like symptoms.  By the evening of her second day of admission, she complained that she had not yet been seen by a physician.  Another complained that a family member had just been diagnosed with Type I diabetes, but was initially given an appointment with an endocrinologist in six weeks—completely unacceptable in this situation by any standard of care.  I am of course compelled by pride to speak up and defend my profession, but not without an increasing sense of embarrassment for what used to be considered a noble calling.

After I published my piece on the fatal shooting of Dr. Michael Davidson, I was contacted by Carey Goldberg, reporter and co/host of CommonHealth (http://commonhealth.wbur.org/) and asked what struck me the most about the nearly 200 comments left on the essay when it was picked up by KevinMD.com.  Here is what I replied, “There were several reasons that Dr. Davidson’s death hit me particularly hard, even though I never met him.  One reason was that I trained at the Harvard teaching hospitals, Beth Israel for Internal Medicine and MGH for Radiation Oncology, so this hit close to “home” especially with my daughter being there.  But more importantly, I come from a medical family–grandfather was a dentist, father (now 89 years old) is a world renowned plastic surgeon–and in my lifetime of 61 years, I have seen the sad decline of public affection and respect for physicians.  When I was a child, people would stop me on the street to tell me how wonderful my father was.  Now, when I sit in on conversations among people who do not know I am an MD, I hear nothing but derision if not outright hatred.  There are many, many more people, as evidenced by the response to my blog piece, who feel slighted not only by “the system” but also by their physicians.”

And why not?  Articles such as this, http://www.nytimes.com/2015/01/30/business/medicare-payments-surge-for-stents-to-unblock-blood-vessels-in-limbs.html on the front page of the New York Times continue to erode patients’ faith in their physicians to “do the right thing.”  Patients despair when they cannot get appointments to see their doctors in a timely fashion and when they are seen, that their doctors don’t spend enough time with them or explain things to them.  They despair over the cost of care in increasingly difficult economic times. But doctors are in despair also, at the ever increasing bureaucracy of medicine, the insurance conglomerate which makes documentation, authorization and billing a nightmare, the takeover of large segments of medicine by for profit corporations and the heightened expectations for positive outcomes fueled in part by misleading advertising by those same corporations.  Many have come to feel that the sacrifices, both personal and economic, that they made in order to go to medical school were just not worth it.

I do not pretend to have any answers to the multiple crises that contributed to the death of Dr. Davidson, or the current climate in which doctors and patients must function.  I wish I did. But I do have a request for both my patients and others, and my physician colleagues, as well as my Facebook friends and the media.  Let us try once again to see the good in one another again, and not just the bad.  We’re all human, and at some point we are all going to get sick.  For better or for worse, we depend on one another.

THE FREEDOM TO BE NEEDED

Doctors lie all the time.  Call it hubris “I can do THIS for you!”, call it denial  “I KNOW you are going to get better!”, call it what you want.  But nowhere do they lie more than when you ask them if they want their children to go to medical school.  Most of them come right out and say, “Never!  If he goes, he’ll be $200,000  in debt when he finishes.  And besides, you know the practice of medicine is not like it used to be—it’s all about paperwork, and insurance authorizations, and seeing your quota of “X” patients per hour.  Get ‘em in, get ‘em out, don’t look back.  I DON’T want my kid to study so hard for 4 years, and then another 3-6 years of residency where he’s paid a subsistence wage, to finally finish and deal with the sorry state of affairs we have now.”

My husband and I were pushed HARD by our parents when we were kids.  As the eldest children in our respective families, many expectations were placed.  It wasn’t enough to do well in school  (“What’s the matter here—you have all A+’s except in math—you got only an A?  What happened???) or in athletics (“Go swim next to Marilyn, and BEAT HER!”)   It was pervasive and it was truly unpleasant.  Both of us left home when we were 17 years old, and never moved back in again.  And we vowed, repeatedly, that we would NEVER do that to our own children.

So when our eldest went to college, and showed a strong interest in film and photography, we did not bat an eyelash when she decided to major in film studies.  And when she graduated and could not find any paying job in the industry (“no, honey, I will NOT support you while you spend the next year as an unpaid Go-fer for a screenwriter, no matter how famous she is!”), we said “yes” when she decided to go to cooking school in London, spending the last bit of cash I had set aside for her to go to graduate school.  And we were supportive and enthusiastic when she returned from cooking school and got a job as a line chef at a fancy downtown restaurant, despite the fact that she made minimum wages and had no benefits whatsoever—health or retirement.

Sometimes epiphanies are hard to come by.  Mine came after my sophomore year of college where I was an honors English major.  I was backpacking and youth hosteling through Europe with my roommate and we were on a train from Brindisi to Rome.  By the time we ran for the train as it was pulling out of the station, there were no available seats.  So we stood up in the aisle the entire trip, which was overnight.  Unlike my horses, I do not know how to sleep on my feet.  An overnight trip surrounded by sweaty co-travelers reeking of garlic would not SEEM to be conducive to self- exploration, but oddly it was.  I thought about what I wanted to be when I grew up.   I loved English literature, particularly poetry.  And then I thought about what teaching jobs were likely to be available to me—perhaps a job teaching remedial English at a local junior college?  Or a low level editor at a publishing house (back when there WERE publishing houses)?   I knew already that there were people in my class who were destined to teach at the Ivy Leagues—they had won poetry awards, they had developed a new way of looking at Chaucer, they could read and speak five languages—in short, they were brilliant.  That was not me.  On that hot July night, on that train, standing up swaying and lurching, it came to me that when I was in high school my most rewarding experience had been working as a candy striper at a spinal cord rehabilitation center.  I was APPRECIATED.  I was NEEDED.  And that was the night I decided definitively to go to medical school.  And besides, I knew that Daddy would be so proud.

I think that my daughter had a similar epiphany.  Cleaning splattered grease off the ceiling from a ladder in that hot kitchen at the restaurant at 2 am, to take home a wage that would never allow her to move out of our home, she assessed her skills, and her history, which was that she was always the care giver—to her animals, to her brothers, and sometimes even to her parents.  She knew that she was very good with knives and with her hands.  And without much ado, and very much like her mother before her, she decided to go to medical school.  Which I am not ashamed to admit, pleased me greatly.

My daughter will finish medical school in less than a year.  Right now, she is in Zambia, at the CURE hospital there, working with my father, a retired plastic surgeon, on correcting birth defects, and lessening contractures in children who have suffered horrible burns from the main resource for cooking in that country—charcoal.  She is the third generation in my family to go into medicine, fourth if you count my grandfather who was a dentist, and my husband’s grandfather, who was a veterinarian.  This trip will be life changing for her—of that I am certain.

When I was a medical student, a very smart man who was doing his Pulmonary fellowship at Stanford said to me,  “Medicine is the freedom to be needed”.  That is a statement I have never forgotten.   And if you ask another doctor whether they would want their kid to become a doctor and they say “No”, trust me, they are lying to you.