We have made it through another academic year. We will welcome the Class of 2015 into the fold of graduates (from undergraduate programs, medical school and other graduate programs). I always try to reflect on what has been surprising for me during this past academic year and what goals I will set for myself (as a professor and as a physician) for the upcoming year. I am reminded of my own graduation from medical school with my hopes and fears of the unknown aspects of starting the next chapter in my career/life. Now, many years out, I am very happy that I see that I have challenges ahead, goals ahead and things to reflect upon.
As this year comes to a close, I am surprised that the gaps in delivery of health care to under-served populations is getting worse and not better. I have seen people come into my office with conditions that have been left for years that could have been taken care of in early stages but now are life-threatening. I read many medical journals each week to keep up with new advances yet seeing a patient with end stage renal failure because of untreated/improperly treated hypertension and diabetes is rampant. My colleagues who are on the front lines of treating under-served populations are frustrated with systems that still marginalize their patients, are frustrated with fighting for and not being able to see their patients get even basic medical care.
I am surprised that there is a disconnect between those who are responsible for running health care systems are so dedicated to making a profit that they are comfortable with denying services to people who desperately need them. This disconnect is getting greater. I don’t understand how those CEOs can look only at the “bottom-line” and not see the implications of their decisions. Running a health care system is not like running an oil company or a bank. If patients don’t have access to basic health care, they don’t have life.
I am surprised that many of my colleagues can look at patients and blame them for getting ill. Being sick is not a moral failing but a fact of life in terms of being alive. Yes, one does need to look at lifestyle changes that will enhance health but it’s not a personal or moral failing if patients are not able to make those changes. In this time of economic troubles, many patients simply do not have the financial resources, community resources to make the lifestyle changes that will enhance their health. We also have companies that again, look for providing the cheapest foods (usually fatty and sugary) while making healthier food choices far more expensive. Many of my patients eat from the fast food “dollar menu” not because they want to but because they have to. They are simply making choices that allow them to live indoors and are one pay check away from being homeless.
I am surprised that in this world of so many electronic/web informational resources, my students are less informed rather than being more informed. I say this with a bit of ambivalence because I don’t believe that my students’ lack of information is because that resources are not there but that my students are overloaded and their way of dealing with that overload is to turn-off rather than be selective and critical in their consumption of informational resources.
As a professor, I am charged with providing the critical thinking skills for my students to navigate the world of medical information. We, as physicians, have unprecedented access to the best evidence-based/science-based health care resources in the world. As a scientist/scholar, I am charged with questioning everything that I read regardless of how my information is delivered. Critical thinking and evaluation of the vast amounts of data about populations and individuals is a challenge that I must meet and teach to the next generation of physicians and health care providers. I must and I am constantly striving to evaluate and deliver the best evidence-based medicine based on data and research. I have to be confident that I am making sound decisions and I have to teach how to make sound decisions.
I am challenged to provide preventive strategies to my patients, where they live, that they can incorporate into their lives for the best outcomes. If I overwhelm my patients, they disconnect with preventive strategies and with health care in general. This means that I have to be able to explain what and why I am recommending a treatment strategy and I have to be able to recommend other treatment strategies and why I am not recommending those strategies no matter what they have seen on the telly or read online. I have to keep “one ear to the rail” in terms of what is circulating online and I have to keep the “other ear” to what is sound medical practice.
All of Our Challenges
Practicing medicine is more difficult today largely because of documentation issues. We are clicking away into our computers with poorly designed electronic medical records systems and filling out duplicate “paper work” late into the evenings after a long day in the clinic where we have been charged with seeing an impossible number of patients (again because our employers want us to turn a profit for them). Our challenge is to provide good delivery of health care but we have little support and assistance to do just that. At the end of the day, even if one has completed all of the documentation, there are few feelings of a “job well-done” and more feelings of “I failed on some many levels today.” Our biggest challenge is to remember that we are not the problem but we can be part of the solution by demanding that our talents and energies be focused on our patients and not on “paperwork”.
Our challenge is to look at anything and everything that we can change from within. We cannot allow a flawed system to push us further away from treating our patients because we can’t even “look them in the eye” because we are typing into a computer. We can’t keep skipping lunch, dinner and priceless interaction with our families and loved ones (our sanity) because we are so tied to trying to keep up. We can’t keep looking at the color, size and sex of a patient and dismissing them as individuals with unique needs. We can’t keep “writing off” whole populations of people because they are difficult to treat and because their culture is so different from ours. We can’t afford to say, “It’s someone else’s job and I will just refer them because they are too complex”.
We have to be challenged to take care of ourselves in terms of spiritual, physical and emotional health. No, self-care can’t be our only focus but we need to look inside of ourselves and figure out what is most important for our health and do things to keep ourselves both physically healthy and emotionally healthy. We can’t allow a very flawed health care system to result in our individual spiritual and physical to deteriorate to the point that we become a liability to ourselves and our patients. We have to learn to be selfish with our time and we have to have some outlets that will nourish us spiritually and emotionally. In short, we are crucial to our patients and we have to keep ourselves healthy and happy. Anything less is not going to work.
We have to learn to question everything. Do not just “take the word” of professors, websites, books, journals and other information resources as the only truth out there. Medicine is based on science and not on faith. You can have faith in your spiritual life (valuable) but you have to have the ability to cast a questioning eye on information in medicine. Look at alternatives and look at alternative solutions. Evaluate everything with a questioning eye. It is fine to question someone who is advocating a treatment and it is incumbent upon the advocate to explain their ideas. If you have questions, get them answered and constantly question others and yourself.
Finally, think about your experiences and learn from them. None of us was born knowing everything and our experiences are always learning opportunities. To evaluate yourself and your learning experiences is a very healthy way to learn to discard that are not working and to embrace the things that are working well for us. Always looking for a way to do our daily tasks, job and learning in new ways is a great growth exercise. Again, my professors and my colleagues who constantly questioned me make me stronger rather than tearing me down. We all lamented about those “pimp sessions” but in the long run, they are opportunities for growth and reflection. As long as one is alive, there is opportunity for growth and learning; seize those opportunities.
“Drnjbmd” blogs anonymously to protect the privacy of her patients and students at Medicine from the Trenches.