“We must raise our voices together if we hope to effect meaningful change.”
“If you are happy with your health care, you do not need to say anything, but if you’re not?”
“The only way to do this is through education, one patient at a time, one doctor at a time, one legislator at a time. That requires all physicians to be involved. The load cannot be carried by a few. Organized medicine can act as a microphone, but if there is no one standing behind it, our voices will not be heard. I challenge each physician here to speak out.”
These are all entreaties by me to encourage physicians to take action against forces that seek to control the health care dollar at the expense of the patient-physician relationship. I have met with limited success. I have often stated that a physician’s job does not end when he finishes caring for patients in the exam room. Why is it so difficult to get physicians involved and how does this affect our profession and our patients?
There are so many issues that affect all physicians, yet so many physicians refuse to take even the smallest action. Do they not care? Are they too fatigued to do so? Do they not know what to do or how to do it?
When I was in college, I took a psychology course with Martin Seligman as the professor.
Dr. Seligman promoted the idea of learned helplessness as a model for depression. His experiments created situations where some subjects were administered electric shocks, but could escape the punishment by engaging in a particular behavior. In that setting, they demonstrated the behavior repeatedly. Other subjects were punished regardless of what behavior they engaged in. Ultimately, these subjects just gave up and refused to act in any fashion. Subsequently, these latter subjects refused to act in other situations even though they did have the means to avoid the punishment. He postulated that depression i.e. apathy can be a result of being taught that no matter what you do, you cannot escape the shock, and that this is a learned behavior. I can’t help but wonder if physicians as a whole are suffering from a collective depression due to learned helplessness.
One could postulate that there have been so many forces exerting detrimental changes to health care that many of us have simply given up, much like what Dr. Seligman has described. Burnout has become a popular concept in health care. Maybe, burnout is simply a sense of learned helplessness. We feel that no matter what we say or do, we cannot effect change so why bother. Furthermore, many of us are so focused on our individual patients that we cannot acknowledge the need to address the big picture. Let someone else do it. I am too busy. This attitude however plays right into corporate hands, allowing bureaucracy to manipulate the system for their own desires rather than for the purpose of improving health care for patients.
There have been some successes. While the American Board of Internal Medicine (ABIM) still insists on assessments that require timed questions, they will be instituting a longitudinal assessment, where physicians can move at their own pace, with any resources they want, at home. This is a far cry from the 10 year high stakes exam, where physicians needed to place all their belongings in a locker. While the changes made have not completely resolved the problem (removing the timed component to questions would go a long way toward that end), there has been progress made. That progress has come from the repeated statements and efforts by the Pennsylvania Medical Society (PAMED) and physicians. Change does not come easily or quickly, and it requires physicians to express outrage over and over repeatedly.
Another example is venue, where a committee of the Supreme Court planned to revert the ruling on venue back to pre-2002. This was vigorously opposed and has been put on hold due to aggressive lobbying. Another example of success includes scope of practice, where PAMED has so far been able to delay the state from instituting unsupervised practice for those without a medical degree, medical license, or medical training. We must also remember the successful lawsuit regarding monies that were taken from the Mcare Fund a number of years ago. These things do not just happen. It takes repeated effort by physicians, lobbyists, and the public to educate those who make the rules about the potential ramifications of their decisions, and there is so much more to do, with Pharmacy Benefit Managers (PBMs), surprise billing, Maintenance of Certification (MOC), prior authorization, etc. The task is daunting and does seem insurmountable. Why bother?
A famous quote attributed to both Wayne Gretzky and Michael Jordan says, “You miss 100% of the shots you don’t take.” That applies here. It may not be easy, but without doing so, there is zero percent chance of effecting change. We will continue to suffer from the effects of those who are destroying health care for their own gain. When I die, I would rather say that I went up to bat and struck out against difficult odds, than that I did not have the courage or the will to even get into the batter’s cage. I will not let them win without even trying.
Our patients rely on us not just for their individual care, but also to ensure a system of health care exists that serves and protects them. That requires us to do more than just order the right tests or prescribe the right medicine. It requires us to be brave and persistent and to speak out. It requires us to be informed. It requires us to act when organized medicine, like the Pennsylvania Medical Society (PAMED), presents action items. It requires us to educate legislators, one at a time, as to the issues that compromise patient care. If we cannot do any of these things, then we cannot say that we have acted in our patients’ best interests collectively.
PAMED can lead, PAMED can direct, but it takes an army to be heard. I carry my soapbox with me at all times. There is plenty of room on it for you to join me and PAMED, unless of course you are happy with our current health care structure and the ways that it adversely affects us and our patients.
After all, this is our profession. These are our patients. Let’s fight for them. Our profession depends on it. Our patients depend on us.