Doctors who make the dysfunctional health system work

Now that it has been a couple of weeks since finishing my family medicine rotation, it struck me on the invaluable lessons I learned there from two amazing preceptors. My family medicine experience was in a community group practice based in the city where I am doing my rotations. This city is in a suburban/rural environment with an incredible mix of patients … the age range one day was from a days old infant being my youngest patient, and the oldest a spry, successfully aging woman in her mid-90’s…with every conceivable point in between.

The practice consisted of what is termed “full-spectrum” family practice, general practice and obstetrics combined, and my days were filled with the normal clinic, along with time in the hospital and labor ward. In my preceptors, I received the best of both worlds, a newer staff partner, and the senior partner in a democratically selected group practice. Both well read and versed in making a practice work, both inside and out. They were both efficient, demanding of themselves and my efforts, challenging in every good way that you hope for as a student. However, the best lesson came about health care in general, and medicine in particular just in passing when talking about reimbursement, practice management and health system. One day when talking with one of my preceptors the subject of profit came up:

  • What does profit mean in health care? (Can keeping people from getting sick be profit?)
  • Who should profit? (Doctors? Patients? Stockholders?)
  • When is profit a bad thing?
  • Is it a bad thing?

These questions asked by someone who is living out the answers with a spreadsheet all while seeing patients in the hospital every day are much different than in a dry discussion of health care reform taking place in a small group or classroom, they are so much more real. The lesson I learned is that we all have to keep your eyes and ears open, and look to those that are making the health care system work now despite the dysfunctional environment in which we work, and that some of the real heroes are the family medicine physicians who make it work every day. With or without help.

Michael Moore is a medical student who blogs at The Lancet Student

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