It is time for physicians to stop making the easy decisions

As Americans, we love to associate with groups. More than that — we love to plant ourselves in a group, stand firmly in our decision, and then adamantly refuse to budge or to see the other party’s perspective.

Pro-life. Pro-choice. Democrat. Republican. Pro-Obamacare. Anti-Obamacare.

I suppose for all of us, myself included, it is easy to identify with our group of choice when we are sitting at home watching or reading our news source of choice. It is easy to stand firmly in our decision when we are in the comfort of a two income family with adequate health insurance and ample preventative care. It’s easy.

However, what do we do when faced by the devastating spectrum of inequality in health care that is so prevalent in the United States today? It is far less easy to classify one as a liberal or conservative, Democrat or Republican, and to embrace all of the associated beliefs and tenets when someone is sitting in the room in front of you crying because they can’t afford health care.

It’s far less easy to be so firm in our convictions that we are unwilling to move when we are telling the sunburned, hardened construction worker that the treatment that saved his life isn’t going to be covered by his insurance. It is far less easy to be convinced that we — regardless of whatever umbrella we use to classify ourselves — are right when the patient in front of us is being rushed to the emergency room, near death, while weeping because they know they can’t afford the bills that are coming. It is incredibly difficult to hold firm to these arbitrary convictions when we are telling the homeless man or woman that they cannot be provided with care.

The truth is that it ceases to be easy when the people are real. It ceases to be easy when we are making real decisions that impact real people. People with jobs, lives, and families. People who are being thrown into the despair of poverty because they want to be well.

I believe that it is time for physicians and those in the health care field to stop making the easy decisions. It is time to throw aside our arbitrary ideals and tenets and remember what brought the majority of us into the field in the first place: patient-centered care. I am firmly convinced that is not the political party, belief system, or theory of practice that should unite us. What we do need is unequivocal commitment among physicians to put aside the entrapment of rhetoric and embrace the patients who are sitting in front of us. The patients that are real people lost in a real system that seems to have ceased to care. I don’t claim to have all of the answers — or even one of the answers — but I do believe that unless the medical community embraces the teamwork that is inherently necessary for success in our field, we can only head down a path that perpetuates this unhealthy system of care in the United States.

Kathleen McFadden is a medical student.

Comments are moderated before they are published. Please read the comment policy.

  • James O’Brien, M.D.

    Falling back on platitudes while pretending differences of opinion are irrelevant is a perfect example of an easy decision.

    • NewMexicoRam

      Touche.
      So true.

    • PoliticallyIncorrectMD

      Ironically, the differences of opinion only effects which political or professional group benefits from it. Regardless, it still sucks for the patient.

  • lurking for answers

    There is no ultimate cure for poverty or illness, perhaps only death. You can treat every poor person in the nation, but there will ALWAYS be someone with less and someone with more: money, health, love, talent…

  • PrimaryCareDoc

    A tale full of sound and fury, signifying nothing.

    Please, Ms. McFadden, what “easy decisions” are we physicians making? Do you have an actual suggestion to solve health care inequality?

    • Kathleen McFadden

      Thank you for taking the time to read this post–it has been interesting to see the division of opinions. As I stated in the post itself that I don’t claim in any way to have the solutions and answers, because perhaps it is not one person that can change an entire system. In fact, my lack of answers was almost my point–that it is going to take unity among all of those in the profession to drive true, positive change. There can be no solution until there is some level of unity and agreement. Until our focus is re-established on patients and not political semantics, how can ever begin to make the improvements that we so desperately need? I wrote this post not to claim to have answers, but to appeal to physicians to unite in their focus and passion. As for the easy decisions–I think this is perhaps the easiest one of all: sitting back and doing nothing to advocate for ourselves or our patients while simultaneously complaining about the challenges in our profession. Thanks again for your thoughts, it is always good to be challenged to re-think our position.

      • Robert Luedecke

        Kathleen, I very much appreciate your courage in this very well-written article. It is very good to remind all of us that a great many patients do not have the advantages many of us do. “They should just work harder” is good advice, but how helpful to the couple who both work minimum-wage jobs (in a state that did not expand Medicaid) after dropping out of high school to take care of their children? Or more to the center of the nation, how many average families can afford to spend $14,000 as their share of a $120,000 bill for fighting leukemia? This was an actual case I know of and the patient is very fortunate he has a physician’s income. We tend to get very isolated in our own little worlds and the reality is the US healthcare system does not work for a very large number of very responsible people.

  • QQQ

    Anyone but perhaps a medical professional can look at a hospital bill
    and not have a clue what they are paying for. Lab work and X-rays are
    particularly entertaining? When you get to the bottom line the big
    number sticks out. If you are lucky enough to have insurance coverage
    and you see what the hospital got paid you scratch your head. The
    difference between what was billed and what the hospital got paid is
    amazing. The poor person without insurance would never be able to afford
    the bill?

  • PoliticallyIncorrectMD

    While I am usually skeptical about medical students’ posts on this forum, I felt I need to speak up in support of this one. Why so much hostility? Her thesis is clear: forget your political (or other) agendas and put the patient first! What is so objectionable in this thought? Many physicians (including yours truly) would agree that this is the only way to practice medicine.

    • James O’Brien, M.D.

      Just see the patient and ignore politics and economics…you can’t do it even if you try…how’s that working out for doctors? Should we just stay the course How about putting the patient first BY paying attention to politics and economics…because the changes in medicine are doing everything but that. Ezekiel Emanuel believes in treating society first rather than the individual patient.

      • PoliticallyIncorrectMD

        To the contrary! Do get involved in politics and economics! Just don’t always vote along your party, professional society or any-group-you-belong-to lines (whatever that party, society or the group is). Your only (!) allegiance should to your patients. That what “making hard decisions” is in author’s terms.

        • Kathleen McFadden

          This indeed was my point! I appreciate the thoughtful discussion on this post, although perhaps some have misinterpreted my thoughts. First, all of these situations above are things that I have personally experienced. Second, I don’t mean to oversimplify incredibly complex issues, but instead my intent was to speak to the fact we get so caught up in the rhetoric of “our group” that we fail to see that we ARE forgetting patients. If anything, I advocate for greater involvement in politics, etc. but a solemn, informed involvement where we abandon arbitrary party/group lines and instead unite as a body of physicians with a single-minded focus of improving what is clearly a flawed system. The comments on this post perhaps reinforce my very thoughts–we are often so defensive of “our group” that we seem to lose sight of the goals and ideals that brought many of us into this career.

          • PoliticallyIncorrectMD

            I would like to prize you for your approach to Medicine. I warn you, however, that many in the field do not share your attitude. Recently I was told the following by one of the regulars of KevinMD community: “In my time the old saw of going into medicine “because I want to help people” was used only for medical school interviews.” This is very sad, but I hope people like you will make a difference.

    • southerndoc1

      “when we are telling the sunburned, hardened construction worker that the treatment that saved his life isn’t going to be covered by his insurance. It is far less easy to be convinced that we — regardless of whatever umbrella we use to classify ourselves — are right when the patient in front of us is being rushed to the emergency room, near death, while weeping because they know they can’t afford the bills that are coming. It is incredibly difficult to hold firm to these arbitrary convictions when we are telling the homeless man or woman that they cannot be provided with care”

      How does “putting the patient first” improve any of these terrible situations?

      • Kathleen McFadden

        Certainly, no one can completely remove the devastation the above situations wreaked on these patients’ lives. However, I believe that taking a purely pessimistic approach and making generalizations such as “no one can ever eradicate poverty” is never going to make the system better. We have to have hope, we have to start somewhere. Of course things cannot ever be perfect, but my challenge to each of us is to question how could they be better. Are we truly doing everything we can do to provide patient centered care? Are we fighting for our patients instead of settling for the status quo? My thoughts stem from the fact that if the physicians in our country were to unite on the fact that we are putting the focus back on the patient and making decisions based on what will overall improve their care and the systems that drive it, maybe they would never need to face such devastation in the first place. Perhaps I am not far enough along in my career to be so jaded as to believe that we are too far gone to make changes in policy and practice that would prevent our patients from ever have to experience such tragedy.

        • lurking for answers

          I will readily admit that I am both jaded and pessimistic; I’ve been stuck in “this system” as a patient for far too long. I’ve been misdiagnosed, mistreated and left at the status quo and told that I should be happy with it.

          You are dealing with two issues here though: caring for patients AND financial responsibility.

          I wish they could be separated, but I can think of no society where that has happened. You can see the patient for free and advocate that they get the best care and treatment, but that care and treatment WILL have a cost. Who will pay for it? You? Society? Government simply takes (taxes) a portion of Society’s money, it is not an endless supply (this is where politics comes in.) To treat EVERY person to the utmost of your ability is a noble and right goal, but the sticky point will always be the cost.

  • JW

    Good post, thanks.

Most Popular