In a few weeks, I will be retiring. After 31 years and more than 100,000 patient visits, I will be hanging up my stethoscope. Over the years, there have been tremendous highs but also horrible lows. The latter includes having been victimized by a frivolous lawsuit where my patient suffered injuries attributed to a medicine prescribed by another doctor. I was named in the suit, simply because I was one of her doctors. My lawyer informed me that the case’s facts would not matter in Philadelphia, which is notoriously plaintiff-friendly. I was young and naïve, and I settled the lawsuit due to the venue, even though I knew I had done nothing wrong.
More problematic was when I was brought before the State Board of Medicine (SBOM) for prescribing high dose opioids to a chronic pain patient. This was well before the current opioid crisis, and I was appropriately following the standard of care of the time. The SBOM used an “expert” to testify against me, whose only training was a 1-year internship in family medicine in the 1960s. This hired gun provided blatantly fraudulent testimony, completely ignoring the facts. I described the events of this case in the Journal of Medical Practice Management in an article entitled “The Facts Did Not Matter.” The title was appropriate, given that the SBOM was not interested in the truth. I later learned that they were looking for an opioid case to set an example for physicians, and it did not matter that the facts of the case did not support their agenda. Fortunately, I survived both cases, albeit with a residual of PTSD, but I am stronger for having endured them. These experiences galvanized me to become an advocate for health care reform.
Fortunately, there has been much more good than bad.
Allow me to share the story of a patient who had Churg-Strauss, a potentially life-threatening form of vasculitis. I was able to shepherd him through difficult times, and he survived. He often would come into appointments with his wife, and we became friendly. He worked out at the same gym as me, and I would talk with him there. One day, he informed me that he would be moving to Florida. His wife came in with him to his last appointment and said words that still bring tears to my eyes even now. She advised me that the next time I become upset with any of the many things in health care that agitate and frustrate me, I should remember her husband and know that not only did I make a difference in his life, but that I also impacted the lives of all who love him and still have him around. I think of her words often, and they have helped me to keep my priorities straight when the bureaucracy and injustices in health care seem insurmountable.
The single greatest joy in medicine is knowing that you have made a positive difference in someone’s life. I have been fortunate to have experienced that many times. In his novel, The House of God, Samuel Shem writes that the most loving thing we can do as physicians is to “be with” the patient. We cannot always cure. We cannot always relieve suffering, but we can always “be with” the patient, i.e, share their lives, commiserate in their sorrows, revel in their joys, and most importantly, validate their experiences. The caring may actually be more important than the curing. This is the “art” of medicine and is why the patient-physician relationship is the core of health care.
However, this core is being systematically torn apart by those who seek to control the health care dollar. Issues such as prior auth, venue, surprise billing, middlemen, MOC, lack of transparency, etc., are all destroying our health care system, and patients suffer because of them. I have written many times on these issues and will continue to speak out against policies that harm patients. The injustices of my legal cases have served me well in this regard, as my start in advocacy was in the realm of tort reform.
As I retire, I do so with mixed emotions. I will not miss the bureaucracy or the endless entry of meaningless data, but I will miss my patients, staff, and colleagues. Impending retirement has caused me to self-reflect. I depart, recognizing the importance of what I have done over the years and what physicians across the world do every day. This has never been more obvious than in the current Covid crisis and should not be taken for granted. Yes, I am proud of what I have accomplished and the care I have provided, but my gratitude greatly surpasses my pride. The memories I have accumulated are a treasure whose value is priceless and one for which I will be eternally appreciative. You see, I realize that although I have tried to benefit patients over the years, it is I who have benefitted even more so, by my patients allowing me to “be with” them and become part of their lives. And that is the most valuable lesson I have learned.
Mark Lopatin is a rheumatologist.
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