Do you think of yourself as a healer and patient advocate? If someone asks, why did you go into medicine, do you respond "I wanted to help people"? Do you go to work thinking that your mission is to contribute to the greater good? I hope so. That is why many physicians elected to go into medicine.
But how do we spend our time?
Many of us are told our patient visits must not exceed 14 minutes. If patients want to talk, they must compete for our attention with a computer screen.
If patients have a complaint outside of the focus of their visit, they get a referral.
If patients do not like us, our healthcare scores are adversely affected. If we prescribe a new drug, we need to spend hours getting approval.
If someone asks if we keep up with medical advances, we are speechless. If someone tells us tomorrow that our patient visits must not exceed 13 minutes, we work faster.
Some readers will say that this depiction does not apply to them, but I do not believe them. I suppose that a few physicians might practice in a world that resembles the one that existed 40 years ago, but I do not know any.
If you believe you are special, you are either extraordinarily fortunate or perhaps delusional.
If you think that you control your professional life, I have a bridge in Brooklyn to sell to you -- at a reasonable price.
Some physicians are dismayed that they can no longer act in their patients' interests. They look at their medical practice and wonder: "I want to do the right thing, but I cannot do it alone. If I could only get physicians to act collectively, together we could change the rules."
If you believe that, I have a parable to tell you.
"Tomorrow you receive an email from a governmental agency, which tells you that you must attend a mandatory meeting of all physicians in your district. The meeting is of utmost urgency. You change your schedule so you can attend; so do your colleagues.
"At the meeting, several officials make formal presentations in a serious tone. They announce that there is no longer enough money to take care of everyone in our usual way. Dollars for medical care have been exhausted, so access to healthcare must be rationed. Every physician will be provided with a budgetary limit. The officials regret this new policy, but the measures are unavoidable. They realize the strain this will place on doctors. Therefore, to compensate physicians for their extra trouble, the salaries of all practitioners will be increased by 20%. However, you will receive your additional 20% only if you maintain expenditures below the assigned spending level.
"There are 2000 physicians in the room. None are happy. A few ask questions. One doctor shouts loudly about the lack of fairness, but she is quickly subdued. Most of the physicians in attendance simply grumble. When the meeting ends, they go back home and talk to their families. The next day, they comply."
Does anyone believe that this is a hypothetical story? Does any reader doubt that the ending of the parable would transpire as described? Can you imagine that this meeting already occurred years ago? Do you understand that you are already complying? Do you think that you will continue to comply?
If this parable sends shivers down your spine, consider yourself very fortunate.
At least, you have a spine. When the pressure is really on, some physicians may forget that they have one.
Disclosures
Packer has recently consulted for Amgen, Boehringer Ingelhim, Cardiorentis and Sanofi. He was one of the two co-principal investigators for the PARADIGM-HF trial (sacubitril/valsartan) and currently chairs the Executive Committee for the EMPEROR trial program (empagliflozin).