By Sid Roberts, MD
Lufkin Radiation Oncologist
This article was originally published at Houston Chronicle and is reprinted here with permission from the author.
I am a physician. Being a doctor defines me. Whether I am seeing patients in my Cancer Center or dining at a restaurant, I am Dr. Roberts. I have expectations of myself in my role of physician, certainly. But the broader community has expectations of me, as well - expectations of competence, compassion and especially availability. Surveys and patient satisfaction scores, however, show that physicians are not meeting those expectations.
I see two broad reasons for this disconnect. One is related to how we practice medicine in the 21st century (in front of a computer rather than in front of our patients). The other has to do with what we see our role to be as physicians.
As a member of my hospital's Performance Improvement Committee, patient safety is our primary concern. Too often, though, we get bogged down in an ever-increasing slough of statistics. Some data we need to track (mortality rates, infection rates, etc.) but other data (such as whether patients think the bathroom is clean enough) are, to put it mildly, distracting.
Chasing data has become the focus of American medicine, and the individual patient has been lost in the process. On top of this is the stress and frustration of working with a bloated and perversely incentivized health-care bureaucracy that views every failure to dot an "i" or cross a "t" as fraud and abuse. Not surprisingly, not only has patient satisfaction declined, but physician satisfaction with the practice of medicine has tanked as well.
It isn't simply about computers and bureaucracy. Since I started practice in 1991, the percentage of physicians in private practice has dropped dramatically. The "New England Journal of Medicine's" CareerCenter website posted that physicians coming out of residency are increasingly gravitating toward contracted rather than private practice positions. Anecdotal reports put the desire to be employed as high as 80 percent. Various reasons are given, including the uncertain direction of health-care reform, declining reimbursement and rising overhead costs. Increasingly, physicians just want to show up at work, practice medicine (without having to deal with administrative and insurance issues), and then go home. They believe that employed positions offer a more predictable work schedule than private practice.
This growing employment model, not just among millennials, coincides with a major shift in attitude among physicians about their role - dare I say duty? - when it comes to patient care. "Becker's Hospital Review," an industry magazine, noted that physicians increasingly expect their affiliated hospitals to provide compensation for on-call coverage, which used to be an expectation of all physicians who had hospital privileges. By 2001, nearly two-thirds of health care organizations provided call pay to at least some physicians.
In our hospital committee meetings, we - the self-selected 10-percenters who are involved in medical staff leadership - bemoan the loss of a sense of citizenship among physicians. We opine on the privilege of being on a medical staff, and that there are responsibilities that come with those staff privileges. Ultimately, we just want our fellow physicians to "do what is right." That simple ethical imperative is the heart and soul of the practice of medicine. Not just doing what is expedient. Certainly not just doing what you hope (or demand) to get paid for.
I fear this is where we are in medicine today. Being a physician is no longer a profession - a calling, a responsibility - it is simply a job. The art and practice of medicine has been reduced to a series of individual transactions, each separately identified in an ever-complex system of billing codes, rather than an ongoing relationship not just between doctor and patient, but between doctor and community.
How can we recover the profession? How do we reinstill a sense of duty? Of moral obligation?
Medical schools have the initial obligation to provide a strong ethical foundation for the practice of medicine. But organizations that provide ongoing training and continuing medical education are responsible as well. The Texas Medical Board requires two ethics and/or professional responsibility CME credits every 24 months as part of a total of 48 credits required.
The Texas Medical Association, which has more than 48,000 physician and medical student members, offers 62 ethics-related CME courses ranging from communication skills and dealing with difficult patients to stress and burnout and HIPAA compliance. However, there is not a single course on basic ethical principles, which have guided the practice of medicine in Western civilization for centuries. Maybe that is because an ethical imperative to "do what is right" presupposes we know (and are willing to agree on) what "right" is.
The United States Conference of Catholic Bishops produced a document - Ethical and Religious Directives for Catholic Health Care Services - which guides all Catholic healthcare institutions, including CHI St. Luke's Health hospitals. Physicians of all faiths would be well served to read and abide by these directives, which first and foremost stem from a sacred view of human dignity. If nothing else, physicians should re-read the Hippocratic Oath, which for centuries has united physicians in a common, patient-centered cause.
Finally, we should look to physician role models around us. The Lufkin/Angelina County Chamber of Commerce hosts an annual Salute to Healthcare banquet where they honor a Healthcare Professional of the Year, Nurse of the Year, Individual of Merit, and a Lifetime Achievement Award winner. In November, I had the honor again of emceeing the event. As I announced the Lifetime Achievement award recipient, I emphasized the award is not just about showing up at work for 40 years and then retiring. That's just doing your job. What we honor each year is the extra - the above and beyond - that exemplifies a career marked by service not just to patients but to society. I hope that by honoring those who set a great example of leadership, compassion, and generosity over and above medical skill, younger physicians will be inspired to follow these examples of care beyond the dollar.
I challenge my physician colleagues, young and old alike, to "do what is right" by all patients. This is your profession, if you will still claim it.
Roberts (@srob61) is a private-practice radiation oncologist at CHI St. Luke's Health Memorial in Lufkin.