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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  • Anonymous

    I whole-heartedly agree that family medicine physicians are real heroes, no doubt about that.  As such, when they are truly saving lives, they should be able to feel secure that their staff is helping them out with keeping the physicians’ good reputations since they are also in direct contact with patients.  However, with my personal experience as a patient, I feel that this is not always so and believe it is an important issue to also keep in mind when discussing the health care system.

    Often more times than not, I have been frustrated and left disheartened by having to follow up with staff several times because of not receiving a callback as promised or unfriendliness.  I definitely understand being overworked and having to deal with naturally unhappy people.  What I do not understand is if staff realizes their behavior could potentially affect the physicians’ reputations.

    I am not saying the patient is always right, but the “patient experience” could make the difference between a good patient going to one physician over another.  If it is the nature of physicians to care, imagine what a positive difference it would make to alot of patients if they received the same type of caring treatment from staff?  Especially in today’s age with social media, word of mouth could be the most effective type of advertising based on patients’ time spent with staff (sometimes they see the staff more than the physician).  Also, working in the Marketing field, I strongly believe patient follow-up as being a part of the experience; something as simple as a physician sending a card shortly after a visit just to say they were thinking of them.  I appreciate that physicians are already so wonderful doing what we appreciate them for, but also need to have a real supporting and engaging staff.

    So, my personal experience with most physicians’ staff (not all; I applaud the caring staff) always makes me wonder if medical students are given Business or Marketing courses in school to help support their career as well?

  • ninguem

    All the compliments, none of the pay.

  • Anonymous

    Out of the classroom and into the clinic. There is nothing that beats real-world experience. I treasure what I have learned from all the physicians who mentored me from medical school onward. There is so much we can learn simply from witnessing how we cope (and thrive) amid the dysfunctions.


    Michael, I am very pleased—but not at all surprised—that your family medicine rotation
    provided you with new perspective of what could improve both quality and costs within our healthcare system.  Many more traditional family practice MDs, like your recent mentors, are the answer to many of the system’s quality and cost issues. I believe you did not mention in your article what specialty that you
    are currently contemplating.  I hope that your experience with these invaluable family physicians might influence you to aspire to eventually join them in the good fight for quality and affordable medical care.  If not, then a quick and honest exam of your reasons for favoring an alternative specialty might give you additional insight into the factors contributing to our current dirth of family MDs within the system—hopefully, along with some suggestions for remedying the situation.
         Michael, I believe that the consumer threat, inherent in a system without sufficient numbers of primary care MDs, is irrefutable; especially given the fact that, for the foreseeable future, the majority of patients in the system will have multi-organ-system-disease histories and be on multiple drug regimens—while the majority of the system’s MDs will be trained in focal organ system, or procedural specialties!  The broad scoped, multidisciplinary academic credentials, possessed exclusively by family
    practice MDs, unequivocally make them the best qualified of all specialties—for providing first contact care for patients having multi-organ-system diseases and complex polypharmacy issues.
    Unfortunately, the general public, the media, and politicians are not nearly aware of this fact as they need to be—Alan D. Cato MD, F.A.A.F.P. and author of The Medical Profession Is Dead and the Doctor
    Is “Critically ill!” (Oct., 2010)

  • Maryallene Otis

    I have some amazing doctors, for which I am most grateful.  I dread replacing them when they retire.

    As for the profit question.  Profit is a reward for a job well done.  Profit is a good thing.  Where is training, research and equipment to come from without profit?  If the government pays for medical training, equipment and research, they just steal it from other people’s profit.

    Never feel guilty for making a profit for doing the work you love.  Profit is a badge of honor.  Read Atlas Shrugged.

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