The following article supplements my post. I encourage you to read it.
http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html
After reading “How Being a Doctor Became the Most Miserable Profession”, I could not shake the reality that I, and many of you, will face when entering the medical profession. The thought has always been tucked in the back of my mind but recently is has become more prevalent as I step closer towards becoming a doctor. As this nation’s future physicians, how do we change the corrupt healthcare system and medical practice? How do we give patients what they deserve? Is it through policy and large corporate changes that take years to implement? No. To me the answer is simple: we must change from the inside out.
As Edmund Pellegrino writes in The Medical Profession as a Moral Community, “Today, our profession faces an unenviable choice between two opposing moral orders, one based in the primacy of our ethical obligations to the sick, the other in the primacy of self-interest and the marketplace.” Physicians cannot serve multiple cohorts of society. They either serve the patient or they serve the economy, policy or the law. We cannot blame the state of medical care on the outside factors of society. While it is understandable, the blame compromises our moral integrity. We can overcome this crisis “by acting not on the basis of what external forces do to us, but on what they do to those we serve” (Pellegrino).
I cannot think of a better time to apply and practice Pellegrino’s opinion about moral communities than in today’s society. “A moral community is one whose members are bound to each other by a set of commonly held ethical commitments and whose purpose is something other than mere self-interest” (Pellegrino). He continues his definition of a moral community and states that the group must posses the following: “the inequality of the medical relationship, the nature of medical decisions, the nature of medical knowledge, and the ineradicable moral complicity of the physician in whatever happens to his patient” (Pellegrino).
Pellegrino says it perfectly, “only if we have the will to use our collective moral force will the integrity of the profession be preserved.” As future doctors, we must unite on this moral mater and further its foundation in the medical community.
Citations:
Pellegrino, Edmund. “The Medical Profession as a Moral Community” Bulletin of the New York Academy of Medicine 66 (3): 221-232.
Drake, Daniela. “How Being a Doctor Became the Most Miserable Profession.” The Daily Beast. Newsweek/Daily Beast, 14 Apr. 2014. Web. 20 Apr. 2014.
I agree with you that doctors basically have the choice whether they want to be there for their patients as a moral commitment or if they are just being a professional and favoring the success of their own practice. I think that it is definitely easy to say that doctors should prioritize the well-being of their patients, however, it is definitely not easily done. Due to the design of the medical system, doctors are only granted a specific time with their patient that they can’t overlook because they also have other patients that they must attend to.
I actually just read and watched a play called “Wit,” which kind of sums this up because the doctors treated the patient like she was an object rather than a human being. Unfortunately, many doctors are just interested in the research that they can gather by experimenting on their patients rather than focusing on the mental and emotional well-being of their patients.
Because you want to be a doctor, you will eventually have to make this choice too!
This post hits home with me not because I aspire to be a doctor, but because my roommate, and several of my friends are currently on the pre-med track. Daily, my peers wind up discouraged and frustrated, as they are constantly hearing from others how “the field of medicine is changing” along with a slew of other reasons that deter them from their future goals. “How Being a Doctor Became the Most Miserable Profession” is yet another piece of evidence that the future for physicians doesn’t look too bright. Doctors are burdened with a tremendous amount of responsibility. They are expected to appeal to “multiple cohorts of society” despite the impossibility of that option. By encouraging the formation of moral communities, Pellegrino hopes to preserve the integrity of the profession. However, I believe that it is unlikely that patients will be guided by morality without a more personal incentive. It is easy for physicians to succumb to the demands of the marketplace when that is the direction they are being pushed in by society, and by their own self interest.
You bring up a lot of intriguing points. I am in agreement with you on the principle that the ideal way to set our current health care system straight is from the inside out. In a perfect world, the doctors would have a better handle on how they care for patients. Unfortunately, the majority of doctors are limited by the hospitals they work in what they can do for patients. There is a great amount of pressure for doctors to get through their visits with patients quickly. Doctors are also pressured into ordering unnecessary tests and services for the benefit of the hospital. I think the majority of doctors would ideally like to spend as much time as possible with a patient but are restricted by their workplace. Many doctors are frustrated by the circumstances they work in today. At this point in time, the system requires modification to ensure the best outcomes for the patients.
“for things to get better for patients, they need to empathize with physicians”
I think this quote from the article really gets an important point across. As this class has come to an end, and specifically in our last class yesterday, I’ve realized that blaming doctor’s and demanding more from doctor’s is futile. I have a felling that the majority of doctor’s are already doing everything they can. They put in copious amounts of work hours which often results in them not being able to take care of themselves in the same manner in which they preach to their patients. Doctor’s are stressed, they often are forced to skip meals, they don’t get enough sleep… Is this what we should be demanding of our doctors? No. Doctor’s deserve as much care (maybe more?) as we patient’s demand from them.
I like the attitude you have to change the way things are from the inside out. Morally, this is great and I think most of our class would agree that the problems discussed in class would be solved faster. However, it must be recognized that this is not possible at the moment. The financial capabilities were not acknowledged, and without money, even the most ethical doctors can do their job efficiently. There are some stories of doctors quitting their jobs at clinics and starting their own practice based on the principles you mention, but they are few and far between. Most people want to have a well-paying job, and medical students especially since they have arguably the biggest school debt accumulated.
I really enjoyed the article you linked due to its prevalence to several students and I never knew that being a physician could be such a depressing occupation. A great point mentioned in the article is that physicians can never truly win in that they cannot both please the market and the morality/ patient individuality aspect. The inability to satisfy demands on both ends is probably what causes this occupation to become depressing for the physician at-hand. The true debate is between accommodating the market’s self-interest and purely economic viewpoint versus accommodating individuals and acting morally?
I never had a full understanding on the economic aspect of medicine until reading the statistic that insurance forms cost $58 forcing the physician to see at least 24 patients per day to make a subtle profit. These appointments on average tend to be about 12 minutes making them very impersonal and economically focused, which was never the intention of the medical field.
I completely agree with your idea of promoting the moral community of which medicine is supposed to exist within. The only issue I can raise is that if we focus solely on morality and patient individually the medical industry could become unprofitable and ultimately unable to accommodate everyone in-need.
Our system is making it hard for doctors to the best doctors they can be. With limited supply and increasing physician demand, MD are stretched thin, and each physician-patient interaction cannot be optimized maximally. I agree with your comments on the moral community on physicians, and that it would ideal for physicians to band together to morally serve their patients. Yet, these ideals are impossible due to systematic constraints on doctor’s role and function within society. There has be a balance between self-interest, moral service, and following laws/economic standards. While dealing with the system will take broad sweeping policy changes, there needs to be a focus on what the physician can do—especially when our nation is in deficit. The physician ultimately still carries great power and influence in the patient and physician interaction. The focus of ethics should be there on what the physician ought to be doing to best serve the patient. I think your ending call to action is powerful, and this is what should be resonated in medical education. We need to work towards building up the moral community of physicians so they can work the best in their sphere of action. Then the system needs to adapt in order to reward physicians for this service.
Pro Who Might Be Concerned About men.