Dear Doctor, Which one are you?- Patient, Physician, or Specialist?

We are all patients at some point.  Rich or poor, when sick we are worried and vulnerable. We’d all like a cure but at a minimum we want care, reassurance that all can be done, is being done.  Ideally we’d like to have confidence in the person watching over us. This can be a tall order.  As a senior physician, I remember the feeling of helplessness when my mother became a quadriplegic.  I became an increasingly passive participate as she went from hyper-acute ICU care, to inpatient care, to chronic care in a nursing home to home (http://alanpittmd.blogspot.com/2012/08/the-apex-of-care-i-am-successful.html).  Each step “forward” felt like a step back as her care became increasingly fragmented.

For some, healthcare experiences become a calling to serve.  They elect to become a physician, nurse or other healthcare professional.  Having interviewed many potential medical students, many have a naive, idealized view of the profession.  Now in mid life, with longer hours and a much less certain financial future than when I started, I had a somewhat jaded view until recently when my daughter Taylor elected to go into medicine. We had many discussions about a her choice.  Finally, she turned to me and asked what I recommended she pursue in these chaotic times- business, law, research? As a physician she was pursuing a worthy profession.  I couldn’t disagree.

After medical school most physicians specialize. In part, this is financial.  American specialists tend to make more than generalists.  However, this is also a result of the Darwinian selection process. Successful medical school candidates tend to be type “A.”  They want to be right.  Specialists train to know more about less (occasionally to the obscured) than their generalists counterparts.  However, over time, specialists are socialized to think of themselves as specialist first, then physician and then as a patient.  Some forget they were ever young doctors with calling.

The Accountable Care Act (aka..Obamacare) has come as a surprised.   Several provisions ask for coordinated care and a team approach, in essence asking for a cultural change for healthcare providers.  With a loss of income and control, many specialists are understandably frustrated, anxious and angry.   Although I don’t expected sympathy from many American’s for the plight of the specialist, earning less every year for the same (or more) work is never easy.  Although most in healthcare recognize the need for change, each group hoped the change would come from someone else’s piece of the pie. 

For many in my profession, Obamacare has become a rallying cry, representing of all that is bad with big government.   However, if you were President, what would you do?  The bills for decades of over utilization are coming due.  Although it remains to be seen whether care will improve for the average American, the current system is simply not sustainable.  Decisions have to be made in the best interest of the patient and the population, not the profession.   My daughter's choice has been a bit of a pause for me.  It has helped remind me healthcare is a noble pursuit, and that specialty care is a by-product of the business but not the purpose of the medicine.  Ultimately, we are all patients first.