As the sun rises in hospitals across the nation, medical interns start their age old ritual of rounding and examining patients. While the old guard may feel that paper and pens are being replaced by impersonal interactions of mouse clicks and scrolling through the electronic medical records; the essence of the intern experience remains the same.
It is a year filled with a roller coaster of highs and lows which adds to the fabric of our experience as a care provider. The transition from a medical student to a resident entails more than just exchanging a short coat for a long coat. It involves the tremendous responsibility that our decisions now have real-life consequences. Patient care is a humbling experience with the twists and turns that occur during both inpatient and outpatient experiences. Trainees like myself naturally go though a period of self-discovery. The natural evolution of an intern as he or she progresses through the rungs of the medical ladder over the years is a medical tradition; as the trainee eventually becomes the trainer.
An intern sits at the bottom of the medical hierarchy which is filled with layers of inefficient bureaucracy and regulations. He or she may feel like a middle relief pitcher, a third line center, or the sixth man off the bench who functions as the proverbial unsung hero. The intern plays an important part as the cog in the wheel of the patient care experience. Everyday is a learning experience and I remain indebted for the opportunity I have been given.
In the medical community, there is a general foreboding sense of fear and uncertainty in regards to the current health care reform process and it’s long-term financial implications. Our duty as modern physicians is to not only provide the best possible care for our patients, but we must also perform our duty in a financially responsible manor. A recent report by the non-partisan Government Accountability Office has stated that the Social Security and Medicare Trustees, the Centers for Medicare and Medicaid Services’ Office of the Actuary, and the Congressional Budget Office have questioned if the cost containing measures in the Patient Protection and Affordable Care Act can actually be sustained over the long run.We are training and practicing medicine in era where we are expected to do more with less. Eventually when the dollar is stretched too far we may reach a tipping where the increased patient burden from the expanded insurance coverage becomes the straw that broke the camels back.
The most effective method of both reducing health care costs and improving patient care is a renewed focus on preventative health. The vast majority of health care innovation and spending is focused reflexively on treatments and complications from disease. One of the golden questions in medicine is how can we improve preventative health care, because as we know the best way to treat a disease is not to have the condition in the first place. Herein lies a unique but likely controversial idea. Currently, health care insurance companies and physicians are like two combative swordsmen in a medieval duel to the death. In this era of expanded insurance coverage it will be in the interest of insurance companies to improve preventative health care measures, because providing insurance at current or increased rates to a healthier population will improve their bottom line. A residual effect from a patient care perspective will be a reduced burden of chronic disease.
Since the depths of the financial crisis in 2009 the Dow Jones Industrial Average has more than doubled in value and this a marker of economic recovery. The International Energy Agency has recently stated that the United States will be the world’s largest oil producer by 2020 and become energy independent by 2035. This competitive advantage could be the paradigm shift required to reignite the nation’s manufacturing base. We could be on the cusp of the second industrial revolution. A stronger and more vibrant economy will improve the general health of the public as socioeconomic status is associated with improved health outcomes.
We must ask ourselves an existential question; despite all the innovations and advances in technology why are emergency departments, hospitals, and physician’s offices across the nation overflowing with patients?
The Organization for Economic Co-operation and Development highlights that across all sectors of health care delivery America spends more than other comparable nations. Regulations and bureaucracies have gotten us into the current situation and it is highly unlikely that further government interventions will be the ultimate solution. A natural response from hospital systems will be the creation of Departments of Efficiency and Safety; it is inherently ironic that increased administrative burden will lead to improved outcomes.
America is well recognized internationally for its successful entrepreneurial spirit we need to channel these energies into new and effective patient care models. As society has tried and failed in a group-think mentality to achieve the ultimate goals wither it is the War on Poverty, War on Drugs, War on Terror, and now the “War on Medical Waste and Improved Patient Outcomes.” The next generation of physicians face an uphill battle against the established agenda and viewpoints of the medical-industrial complex.
The United States of America which is the land of milk and honey is at a crossroads. We can choose the current trajectory of an unsustainable financial path or we can look towards new and innovative methods of health care delivery. Some may not share the enthusiasm I extrude but as I progress through my training and career. I will dedicate myself to become the best patient care provider I can be so that I may reach my true potential and help the maximum number of individuals. The essence of excellence is thus a commitment to both personal and professional development.
Sajeet Sohi is an internal medicine resident and author of International Medical Graduates – A Possible Solution to the Expected Physician Shortage.
