What has the medical community, once thought of as the “ultimate team,” finally come down to in 2019? The “back in my day” sigh I often hear from more senior physicians has inspired me to read several books about the history of medicine. As I devoured them from cover to cover, the excitement of medical discovery, the anticipation of the near-miracles that were about to be revealed, and most importantly, the sense of a cohesive, resolute and powerful team made me dream of those “back in my days” moments. These history books, which read like novels, have one thing in common — medicine was exciting. It was fun and, most importantly, a team sport with one goal: improve the care of patients.
“Back in my day,” says my friend who is now a retired surgeon, “we used to eat dinner together from the left-overs of the cafeteria every night; we used to prank each other; we used to hang out with the nurses and be friends with them.” In some ways, medicine and health care delivery were simpler. Fame was brought on by medical achievements. There was no electronic medical record to consume the majority of a physician’s time. The limited communication methods of the time made it such that most conversations occurred in person. Everybody in the medical team complemented each other, creating a powerful group with one steady goal — prioritize and advance patient care.
Many years from today, I will also be telling my juniors about the “back in my day” era. Yet, my days seem to yearn none of the nostalgic ideals of my predecessors.
Back in my day, medicine became so complex that one could no longer contain it in a human mind, a textbook, or a journal magazine. Most operations that used to require several days of recovery were now done on an outpatient basis. Patients that did stay in the hospital were infinitely sicker and their care more convoluted. Heroic measures were performed on a daily basis because we could.
However, back in my day, we did not have time to joke with each other or to become friends with colleagues anymore. We spent any free minute of our time documenting only to then switch to answering “documentation clarification” messages instead of spending them with patients or colleagues. Most importantly, back in my day, our teams were broken. And this is what hurt the most.
The infamous burnout does not stem from the 80-hour week, nor from our patients who now relentlessly question our 20 years of schooling and experience with a simple internet search. Nor does it stem from the ever-changing field of medicine with which we can never seem to catch up. No, it is not the constantly evolving set of skills that we need as physicians to be able to do our jobs. These are challenges and, as doctors, there is nothing that excites us more than a challenge. What hurts the most in medicine today is that we seem to be losing our sense of purpose.
We chose to pursue medicine because we want to help people, to make a difference in someone’s life in ways that no other profession in the world can do — to conquer these challenges together as a team that is triumphant, even if it is at the cost of physical and emotional exhaustion. The sweet victory of saving a life or comforting one in the wake of their death becomes an addiction to all of us who chose medicine.
What does break this seemingly indestructible team?
Money. Competition. Ego. All these pressures “from above.”
As medicine is slowly becoming a consumer-oriented field, the ultimate team goal trickles down to increasing the value for the institution’s shareholders. Physicians are paid based on patient satisfaction ratings rather than patient outcomes. Saving a life seems secondary to ensuring that the patient was pleased with their hospital stay. Instead of sitting down and comforting a patient or their anxious family, we spend this time on finding the optimal billing code for the procedure performed. Money is a regrettable reality of the 21st-century model of health care as a business, as is the competition among institutions, which at their core just strive for survival. Throughout the training, we are conditioned to do whatever is asked of us and to be “good soldiers.” As health care has consolidated, we are now encouraged to be the good soldiers at the service of the business leaders.
In this dark reality, hospitals might even resort to unscrupulous means of gaining the upper hand. All of these pressures fall on the providers whose tireless work and interaction with patients feed the system. When the focus of discussion becomes the timeliness of clinical documentation, billing, patient satisfaction scores, and relative value units, we lose track of the very reason that makes us exist. Providers are individually fighting for themselves as they try to navigate seemingly infinite administrative requirements. Our teams lose their cohesiveness and become a group of individuals trying to stay ahead of each other in order to survive the harsh reality. Burnout develops from the cognitive dissonance of wanting to help patients, while instead being rewarded by a perverse system with an entirely different objective — money. This leaves many disillusioned and jaded.
I hope that by the time my career ends, the nostalgia of these days will change to become the sweet memory that the previous generations were fortunate to have. I yearn that health care providers will wake-up to their calling, be reminded of what attracted them to medicine, and shift the focus of health care delivery back to improving patient outcomes. While money and power can be used to improve health care, the means of achieving it should not become a burden on the shoulders of providers. Administrative obligations ought to remain in the administrators.
I cling to the hope that we will re-empower health care providers to do what they do best — caring for patients through a cohesive, resolute and powerful team. My story will end with “back in my day, health care providers recaptured their sense of purpose and revolutionized medicine.” Reclaiming our lost autonomy and teamwork requires health care providers of all backgrounds to be involved in hospital leadership. The knowledge, experience, and wisdom that we have as the soldiers in the trenches is irreplaceable and has the potential to strengthen the health care industry. Although our medical training does not focus on business administration, our innate leadership and ultimate desire to do what is right should motivate us to claim a seat at the table.
Ioana Baiu is a surgeon.
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