This comes from a reader who has been following me since the Placebo Journal days:…
Paying Ode to My Patients
I’m writing this letter because I give a damn. About my patients. Since August of 2017, I have been a member of a patient/physician advocacy group, Physicians for Patient Protection(PPP). We formed in March 2016 out of concern for the number of patients we were seeing who had been grossly mismanaged by non-physician practitioners(NPPs) practicing medicine without a medical license.
Put simply, NPPs are being hired to replace physicians. Why? Because they are cheaper. Won’t affect you if you are a member of the C-suite or if you are Oprah Winfrey. It will affect those who don’t have a choice. PPP believes everyone, regardless of their socioeconomic status, has the right to be seen by a physician, if they so choose. But many are not being given a choice. To fight this unconscionable practice, we have attended summits and conferences, written letters, spoken to legislators and various medical organizations, as well as submitted commentary to social media sites and others. Ad nauseum. It is frustrating to say the least. Advocacy is not easy, but it is necessary.
Now I write to you, the public. To explain how most physicians arrived at this place called the “Art of Medicine”. With the hopes that you might understand why we physicians do what we do. For you. This letter represents my view alone.
College, our medical infancy, is where the fundamental knowledge of medicine begins. In the classroom. And the foundation must be rock solid; hence, our formal education must be tight and right. How is one to understand metabolic acidosis without understanding organic chemistry or biochemistry? How does one grasp the seriousness of angulated fractures and level of injury without some concept of physics and calculus? Medical school, our adolescence, builds on the foundation that was begun in college. It is this stage in which we begin to understand the basic pathophysiology of disease and receive the rudimentary education of medical care. It is where we are introduced to the complexities of the human body, the various mechanisms which cause disease and from whence our understanding to properly manage those disorders originates. Visualization is achieved through multiple video presentations, slides, books and other technological advances required to reinforce our knowledge. Repetition is very important. Why? So that our approach to medical management becomes second nature. Practice makes perfect…or damn near. At a defined point in medical school, we segue into the clinical aspect of medicine where we now begin to see what we have learned….in action. In real-time. Here we commence the steps of applying our knowledge to the art of medicine. Clinical correlation. Pediatrics, general surgery, obstetrics and gynecology, emergency medicine, internal medicine, family medicine, psychiatry, etc. All subsets of the human population and its ills. The clinical areas in which we are expected to apply the information we have acquired. But we are not yet ready to be released to practice on the public unsupervised. Common sense and our Hippocratic Oath dictates this. “Primum non nocere”. First do no harm. We must learn more and we must learn well. So we continue this ongoing, circadian, intense indoctrination. It is imperative that we are encompassed by this world and absorb this material, for our ultimate responsibility to the patient demands it. Eventually, our medical adolescence is over. Now we begin young adulthood: Residency. Here we decide on the medical specialty in which we will practice. And we progress to that home for the next 3-9 years. In this stage we sink or we swim. The challenges are massive. The expectations….incredibly high. But we want this. It is our calling. So we proceed and learn even more so that we may become proficient in our skills and confident in our decision-making. All under the magnificent tutelage of those who came before and understand the importance of what we do; our attending physicians. The depth of knowledge we must possess to appropriately manage those entrusted in our care is overwhelming. Mistakes will happen, but they must be minimalized. How does one guarantee this? Knowledge is the key. One must have an intricate understanding of what one is doing and why one is doing it. What is the intended or expected result? Will it benefit the patient or is the risk greater? What are the options? We educate the patients and make shared decisions. How does one teach these things? One doesn’t. To master such skills requires time and patience which enhances communication between us and our patients. The patients are our guides. We are the tools. Tools have to be honed to be of any good. Residency hones us. Once we reach maturity and our educators/mentors/leaders/supervisors have fulfilled their commitment, it is time to leave the nest. There is no shortcut to this long, arduous process. We have been trained exceptionally well. We are ready venture out and use this gift we have been given. This gift we have spent years developing. For you. Our patients. So that you would have the best. To accept anything less than what we have to give would be an abomination to the art of medicine.
You should want more for yourselves also. There is a reason the road to becoming a physician is laborious; our responsibility to you is not an option. Medicine is not an easy road by any stretch of the imagination. Who in their right mind would spend 11-17 years of their life being poor just to be rich? Who would sacrifice time with one’s family, working shifts so long there is no time to eat or even indulge in the release of bodily functions; be harassed by clipboard cops, who possess no medical background, advising one on how to handle his/her patients; get spit at, verbally and physically assaulted and demeaned by patients, yet still come to work everyday to take care of you and your loved ones? Trust me, it would have been a much easier to rob a bank and take my chances. And it certainly would have been more expeditious. Don’t insult us doctors by minimizing our commitment to you because of rhetoric by those who seek to demean and diminish our role. When one has a calling, there is no choice. And becoming a physician was ours.
Currently, there exists much disdain for doctors in the public for issues beyond our control. Don’t blame us. We are fighting for you, you just don’t know it. And we will continue to do so. Now you, the public, our patients, have a decision to make. You either want the best medical care or you don’t. It’s up to you. But don’t you dare say we physicians don’t care, because we do. For the journey we have taken, we have taken for you.