There is a moment in everyone’s life, for oneself or a loved one, when one receives the “diagnosis.” In that moment, eyes meet across the desk and the shell-shocked individual looks up and asks, “Doctor, what should I do?” In that instant, the patient is putting all of their trust in another human being who is trying nothing less than to save a life.
A good doctor has always been a person who has the ability to think autonomously and critically while holding themselves responsible for the accuracy of their decisions. They develop their own inner authority and autonomous thinking through years of being scrutinized and challenged through training and exposure to an infinite variety of clinical scenarios – many of which remain unique (despite what the Internet would have us believe). It is this collection of attributes that a patient relies on during that very critical human-to-human moment.
But in the world of unintended consequences of health care reform, we are systematically dismantling this kind of doctor. We are systematically diffusing responsibility across care providers, undermining treatment authority, dismantling critical thinking and derailing physicians’ moral authority.
Enter the era of Dr. McQueary.
At water-cooler talks and cocktails across the land in the wake of the announced sanctions against Penn State, people are stillasking how a young coach Mike McQueary, brought up in a corporate, big-money team-think approach of college football, could bear to witness the violation of a 10-year old boy in a shower by his colleague and not rush to the child’s aid. Instead, at that moment he chose to walk away to ask his father and the head coach what he should do. You see, there is no “I” in “team.”
Who is such a person?
How did he become that way?
Would a patient in the throes of life-altering decisions want a doctor with such team-think mentality as their doctor?
This is the precisely the right question to ask if we have the patience to do so. Is the creation of doctors like this our intention? Must we believe the narrative of necessity and progress that leads us to accept such a loss? It is a familiar individual vs. collective, relationship vs. system debate. Yet this time the debate is in an arena that has only the stakes of our mortality. Is this worth thinking about?
Dare we ask what we are creating as we move to make doctors shift-workers, business minded. algorithm-driven, group-think, productivity-incentivized cogs in our new heavily-funded health care wheel. Paying doctors for performance standards based on computer-driven check-boxes, guideline adherence and proscribed health care is of more importance than the individual. Health care, then, devolves to nothing more than a nine-to-five series of clicks.
And Dr. Mike McQueary is born.
Wes Fisher is a cardiologist who blogs at Dr. Wes.