August 21, 2015

Something sinister has happened within medicine though it does not have to be this way.  Physicians are largely unhappy.  A poem in the Journal of the American Medical Association, entitled “Fast“, ticks off anger and resentment with every strophe by the clinician author.  The sonnet laments the edginess of patients wanting office visits, lab results and prescription refills with the speed of a drive-up fast food restaurant, but when they are in need of thoroughness, explanations and hand holding, they want the white linen table treatment with the finest wine. The backdrop of the JAMA poem is the patient’s health insurance company chipping away at the physician-patient relationship. The poem ends with the clinician mockingly instructing the patient to contact their health insurance policy administrator and bureaucrats in Washington DC if they want more time from the doctor.

When a man enters a seminary to be a Catholic Priest, or a woman discerns a Religious Life to embrace being a Nun, they explain to their family and friends that they have a higher purpose. They relate that they did not choose their vocation but rather their vocation chose them.  It is pretty heady imagery, and perhaps foolish to those not attuned to the language of God. However, Pope Francis has graced the world stage and reminded all men and women that one can aspire to have a Higher Calling.

Last year I contacted a surgeon at an academic center with whom I had worked in the 1990s for almost a decade.  I was inspired at the time with his dedication and vocation. He was the subject of my essay when I applied to medical schools. When I caught up with him as a medical student to do a medical rotation, I was disappointed. His calling had become a subjugation of his soul. He complained about the Physician Residents being protected by an 80 hour maximum work week rule, accountants having misappropriated physician decisions, and an overall sense of being vanquished. He was angry, mumbled and ran through patient hospital rounds. The JAMA poem captured him very well.  As I followed during rounding of patients in the hospital, I was wanting to stay longer in the patient rooms to stretch out the visits to maybe 5 minutes as opposed to his 30 seconds. In a few days time of shadowing him, I had come to realize my mentor had morphed into something sick. I wanted no part of his shadow. He would ask his patients the same questions: “how did you sleep?  Did you go to the bathroom?  Let me listen to your heart.  Cough. Again. I’ll get back to you later.”  He never did.  He was ticking off tasks on his list.  There was no joy. Likewise with other physicians with whom I have interfaced in my former medical career, I have been told by established physicians and newly minted specialists to “not do it”. They claim they “would never choose medicine if they  had to do it over again”. Rigor mortis had taken hold of the physicians. They were flat line.

I knew their extramarital affairs, their bilking of Medicare and third party payers, their gunning the system. They had contributed to the current cancer in the reimbursement landscape of medicine.

If a Jesuit priest from Buenos Aires can turn a dysfunctional bureaucratic machinery like the Vatican on its head, physicians can do better. Physicians are the reason why medical businesses survive. Without the physicians, Humana and Kaiser Permanente would cease to exist. Physicians can take their patients aside and re-introduce themselves without the voyeurs, the vultures, the business opportunists.  A re-education has to happen on both sides of the clinic table. We need to re-establish the once sacred physician-patient relationship, and push everybody else out of it.

Pope Francis has shunned the luxurious apartments, the limousine chauffeurs, and calls Catholics on their telephones to comfort them.  Sometimes he walks the streets of the Vatican without a police escort and joins blue collar workers for lunch, visits prisoners, goes to the hospital beds of sick children, all because he can. The number of Catholic Seminary applications are optimistic; the number of aspirants to the Jesuits has increased, former “recovering” Catholics and non-Catholics are gravitating to the Bark of Peter. They want to touch the hem of his cloak.  They want to believe again.

There is a lot of good a physician can do today despite the deleterious drones flying around them. Practicing medicine is not limited to acquiescing to business metrics anymore than being the Pope means donning ermine furs and velvet red slippers. Leaders change the world one by one.

If physicians come to embody the type of healer that patients truly long to have, the patients will abstain from waving their health insurance cards and renegotiate their relationships with their doctors. They find money for cell phones, acrylic nails, internet service plans, bling cars, tanning salons, massages and expensive hair stylist appointments. They will work with their physician’s fees if they are given a reason to believe in them again. Physicians must bend to the needs of their patients and work with them on a level playing field. Both need to cede and listen and get reacquainted with each other. Service, listening and demonstrating the values of one’s skill sets go a long way to keeping customers happy and having them come back again and again and again sans third party payers.



Masson V. Fast. JAMA. 2014;312(6):653. doi:10.1001/jama.2014.4986