As the year comes to a close, we physicians feel tremendous uncertainty with the rain of change from Washington. As I approach my third decade of medical practice, I feel more distant from the patient who desperately seeks my attention. I struggle daily to reconnect with her, recalling the fading reasons I embarked on this field, trying to resuscitate the patient-physician relationship which is central to our broken medical system.
Often when my faith in this sacred profession was near broken, an unlikely patient with a bizarre illness that peaked my curiosity and passion, sat me down, thanked me for saving his life, and set on fire the torch which once burned bright and was otherwise dimmed by the smoke of coding, regulations, supervising entities, and rude patients.
When I first stepped onto the clinical wards, an astute teacher taught me a profound lesson: “Learn to listen to the patient. They come with the answer. They will let you know what’s wrong but you have to pay attention.”
“Rick,” a 93-year-old real estate tycoon has been in my current practice for fifty two years. I have taken care of him only for the last eight. “If I could tell my grandchildren to do one thing with their life, it would be to go into medicine to heal people. We have plenty of people who make money, many businessmen, but not enough healers. When I was younger, I admired money, but now that I am older and sick, I respect healers.”
Really? I am surrounded by those who find my earnings laughable when they account for the number of hours I put into my work, the years of training and assumed loans, the liabilities, the troubles of running a small business. But despite the tremendous focus on money, something in Rick’s message rings true. This is the kind of truth that I once knew and forgot.
We physicians know too well how fragile life is, how each cell that divides has the potential to turn into cancer, how young lives are cut short by accidents, by depression, by disease. In the past few years, I have lost several colleagues to sudden cardiac death, pancreatic cancer, suicide by gun, all within a few years of my age.
To be sure there is much to be improved in our field. What should be holy and intimate has been replaced by bureaucracy, documentation and guidelines. Checking boxes. Much of what we document is not to benefit the patient but to get paid for the procedures we deem necessary.
We struggle to establish long-term relationships needed to influence patients, to keep them healthy throughout diet, exercise and preventive measures. But today, in the era of electronic health records, the laptops get 90% of our attention. The eye to eye contact is lost. Regulations set patients against doctors. For example, if a patient complains of chest pain, I, the cardiologist am forced to perform a stress test. For this test to be reimbursed, a rule-out diagnosis is not accepted, and the diagnosis of coronary artery disease must be used, even though in the end, it is found that the patient was suffering from reflux and anxiety, no heart issues unveiled. If this patient applies for life insurance, he will be turned down because of the diagnosis of coronary artery disease used for billing. The patient is understandably irate.
Many fields of medicine no longer accept insurance, highest amongst them, psychiatry. In the past few years, I have found myself in the odd position of treating more depression and anxiety for the shared symptoms of chest pain, shortness of breath, palpitations. Within my exam rooms there is an outbreak of overwhelming misery. There is the perfect storm of disintegrating relationships, financial hardship, and above all, loneliness. Many cannot cope and express near suicidal thoughts. In the elderly, there is a huge lack of family support, loneliness being their greatest disease.
We are at the forefront of a major change in the health care system and are experiencing growing pains. We are also living a dichotomy where technology is rapidly improving our diagnosis and treatment, but finances are not allowing their use. We are treating an aging population, routinely caring for complicated patients that have coexisting multi-organ failure. We juggle increasing number of medications with side effects and interactions to treat chronic conditions with no prospect of cure.
To my colleagues, I say, do not give up! Rather find the initial reasons you took upon yourself to be the healing partner of your patients. Do not forget that patients are suffering and are looking to us to be healed. A large part of healing is listening, caring, and imparting hope. I dare say that if most of us were independently wealthy with no need for money, we would continue to take care of the ill. One day, sooner or later, you too will be a patient. Your frustrations with uncertainty should not add to the illness of your patients. Medicine is unparalleled in its intellectual scientific quest balanced with the privilege of intimate involvement in patients’ lives.
To my patients, I say, do not be angry. Your doctor is not God. Your doctor may also be ill, just like you taking medications, just like you suffering from anxiety, just like you struggling with finances. Be kind, for doctors do more for patients they love. Show respect and you will receive more attention. Ask questions and use your doctor as your partner on the road to health.
To students of medicine, I say, you are amongst the most selfless, dedicated and hardworking elite. A country can only be as good as its students, its future teachers, its healers. You give up much. When your friends are playing, you are studying. When they are earning money in businesses, you are accumulating loans. When they are forming families, you are entering residencies and fellowships. Do not give up your passion for healing as life is not about winning financially but doing something important, something that goes beyond you.
Finally, to the nation, I say this land still remains the beacon of hope for the world. We misuse the terms “terrible” and “catastrophic” for political wins. We must step back and realize that what is truly catastrophic is a natural disaster such as occurred in the Philippines, and what is truly terrible is a child dying of hunger and of poor sanitation. We are merely facing the growing pains of a nation that remains the land of opportunity for both patients and physicians alike and shelters with open arms refugees of political uproars from all over the world. Challenges always usher in opportunities. When Medicare was introduced, there were tremendous difficulties and opposition. In the end, the USA will come out stronger, but what must not be broken is the patient-physician relationship.
Afshine Ash Emrani is a cardiologist and can be reached at Los Angeles Heart Specialists.
