Monday, October 18, 2010

an insider's POV

So…last week I mentioned that I would be returning to work for a couple of weeks (filling in for an ailing colleague), affording me the opportunity to share a few thoughts about medical practice from an insider’s POV. I could use this opportunity to rant and rave about health care reform, about tort reform, about Medicare fraud and abuse, and a dysfunctional coding and reimbursement system. I could snivel about patients who smoke and drink and overeat and then expect the doctor to take care of them when they come in with hypertension, diabetes, and heart disease. I could whine about the ones who come in for every minor cold, every itchy rash, every dull ache and pain. God knows I sometimes do. But that has nothing at all to do with what it means to be a doctor at heart.

This is an exceptional privilege, one that is hard-earned and carries with it huge expectations and responsibility. It requires immense dedication and self-sacrifice…if the work is to be done well. Which, with few exceptions, is what we all strive to accomplish…when we reach into our patients' cholesterol laden hearts in order to understand why they are poisoning themselves with food. When we discover that the reason for this one’s headache or that one’s fatigue is end-stage disappointment or anger or shame that has festered for years. When we meet as strangers at times in their lives when our patients are most vulnerable, when they are sick and frightened and confused. And then we help them heal.

This week I was reminded of the fragile intricacy and immutable strength of the human mind, body and spirit. I did my best to extend compassion, knowledge, and encouragement to the patients I cared for. I saw relief and gratitude and hope unfold under my watchful eye. It humbled me. It filled me with awe. So, it saddens me that the system places so little value on the healing power of the doctor-patient relationship and what it takes to build and sustain it. It saddens me that we no longer enjoy the autonomy and authority to practice medicine with compassion and wisdom and grace because there is no way on Earth to code for that and it takes too much time, anyway. Better, it seems, to keep it short. To stick to the facts. To follow the numbers. Don’t get me started…

So, for me this past week was deeply fulfilling…being back with my patients as well as my excellent colleagues and wonderful staff. It wasn’t too bad getting up at five o'clock to walk the dogs before work. It wasn’t too hard keeping up with the hectic schedule hour after hour. It wasn’t a problem finishing the paperwork at the end of the day. I enjoyed it. What was hard for me was the fact that there was no time to write…no time to look back through my manuscript and my recent revisions…at a time when I feel driven to finish this book and get it out. Which is why I retired in the first place!

What is it that prevents you from writing…or painting, or singing, or dancing…or whatever it is you feel driven to do?

“To students of medicine:
I beg of you not to add to the millions of doctors
who are just doling out medicines.
You must treat each patient with love and compassion
and fulfill the hopes they come with.
Your hands are instruments of peace
and are used to restore life while at the same time
others use them to destruction.
Peace in the world is brought about
not by force but by love.”
--Mother Theresa of Calcutta--
In my next post, I’ll strive to include some inspiration for those of us who have so much we are driven to do and so little time to do it well.

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