The process of becoming an excellent physician is one of mastery. The passion of the child is replaced by the studiousness of the teenager, and the bottomless energy of the young adult. The leap from decision to clinician takes decades. Forged in the steel of experience, trampled by pain and tortuous repetition, ability accrues.
The apprentice guards his knowledge closely. He bows to the alter of the sacred skill that he will do anything to attain. There is nothing above becoming. The mountain has many peaks and valleys. One never quite reaches the summit. There are only gradations of closer.
The height of all these struggles is the clinical visit. When done correctly, the conductor brings order, coaxing each nuance forward at the appropriate time and pushing back. Pushing back.
Mastery of this process, this clinical encounter, means everything. The pride and joy of a lifetime of work is condensed into a moment. This is where knowledge meets art, passion becomes healing. The only thing more sacred than the skill of the trade itself is the motivation that brought each craftsman to this place. The hope to help our fellow human beings is what coats the bottom of the well.
But mastery has its limits. The conductor becomes less effective if asked to also manage the lighting. Nuance is lost if water balloons are hurled on stage during the most dramatic moments of performance. And so it has become with physicians. The dictates of electronic medical records, meaningful use, and preauthorization are destroying the carefully crafted skill of diagnosis and management. The drivel of health care reform has become the fodder of the clinical visit.
Physicians’ arms have been tied behind their backs. Now we are being blamed that no one is guiding the ship. You can’t demand that doctors improve health care quality and cost, yet handicap our most basic unit of skill: our mastery. You can’t complain that we are doing a poor job, yet pull our laser-like focus away from the patient and point it towards a computer. You can’t have your cake, and eat it too.
We complain about salary because it is obvious. In the face of greater regulatory demands, increasing overhead, and more intense scrutiny, physician salary has been flat when adjusted for inflation. For must of us though, money is not the issue. It’s more about value.
The demonization of a once proud profession will not solve our problems.
It will, however, alienate us from those we are supposed to be serving.
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