Modern health care and the Burger King mentality: Sometimes you can’t “have it your way”

It’s difficult to put into words the honor I feel as an emergency physician.  Strangers invite you into their lives, trusting in your training, knowledge, and compassion as they battle crisis.  We are involved in intimate details of triumphs and loss on a daily basis, sharing in tears of joy and sorrow as we fight and advocate for our patients.   It’s a humbling calling that I’ll never take for granted.   We work the frontline of health care, holding the line with the best nurses, techs, and medics with a central focus on the wellbeing of our patients.

There are few moments in a physician’s life that unite across all specialties more than our white coat ceremony.  It seems like yesterday when I, along with 200 other bright-eyed travelers, embraced the journey, raising our right hand and repeating as one.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

These words encompass what it means to be a physician, placing the well -being of our patients before our own as we humbly navigate health care.  These words are just as true today as when first recited by our Greek counterparts nearly 2500 years ago. I would like to say I’ve been the perfect example; unfortunately I’m human.  I can say that it has been an anchoring cornerstone that serves as a constant reminder of my duty and calling.

What is good medical practice?  What is good patient care?  As physicians with increased demands and constraints, are we still fulfilling this oath?  Modern health care has been on a collision course with customer service and the Burger King mentality of “have it your way.”  We live in a society where more is better, no matter the consequences.  This has created a void in health care that has literal life or death consequences.  As gatekeepers of health care, it is our duty to uphold our commitment to “first do no harm.”  How do we fulfill our commitment to patients, grounded in our original oath, while meeting their expectations?

There is innovation in simplicity.  Our society over complicates the innate, returning to the obvious and calling it “revolutionary.” Organic has replaced fortified, and grass-fed beef is the new rave.   As physicians, our ultimate goal should be the wellbeing of the patient.  Unfortunately, society often gauges this by how many medications were prescribed, CT scans were performed, or tests were completed.  How do we manage these expectations?  How do we provide the best care and meet patient expectations, while ensuring that we remain true to the maxim of “first do no harm?”

We achieve this goal with good communication and candid discussions.  For every condition, there is an indication for a test or medication.  As physicians, we are the gatekeeper of this information.   Our obligation to patients is to sit at the bedside and clearly communicate your thoughts and concerns in an understandable manner.  Our patients should understand that a CT scan has the equivalent radiation exposure of nearly 100 X-rays and that more is not always better when factoring in cancer risk.  We should be able to explain why we are performing a laboratory test and what conditions we are trying to diagnose or exclude.    As an emergency physician, I am by no means a minimalist.  I order CTs and blood studies daily while performing invasive procedures.  As a board-certified emergency physician that has taken an oath of commitment to my patients, I understand that there are indications for these tests.  We have a duty and obligation to our patients to diagnose and treat life-threatening conditions while being good stewards of their exposure to risk.

The practice of medicine must be grounded in the central focus of patient well-being.  For me, this is more than a career.  It’s a calling that defines my essence.  We must manage expectations while never taking lightly the trust bestowed.  Honest, basic communication is vital in order to avoid these collisions.  As gatekeepers of health care, we must always remember our oath to the patient and ourselves.

Jeffrey McWilliams is an emergency physician who blogs at Advocates Of Excellence.

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