The challenge for each of us: Finding a way to achieve our best

January 10, 2000

The challenge for each of us: Finding a way to achieve our best. Every doctor has the chance to make a difference, and each one must find a career path to that goal.

The challenge for each of us: Finding a way to achieve our best

Every doctor has the chance to make a difference, and eachone must find a career path to that goal.

By Joel V. Brill, MD
Internist / Camarillo, CA

We all profess to have the same core goals when we enter medical school—helpingpeople, making them feel better, doing good. But somewhere along the way,things change.

Is it because of the dehumanizing way medical students are treated? Becausethe first two years of school are nothing but an exercise in rote memorization(despite the time now spent putting students in white coats to get themout with people)? Because the teaching hospital is a brutal place wherepeople are reduced to diagnoses on a 3 x 5 card? The answer to each of thesequestions, unfortunately, is Yes.

Combine these factors with the overwhelming burden of the cost of medicaleducation, and the fact that many students have families to support, andyou can see where the system has failed its own healers. We substitute "science"for "art," and encourage students to ro-tate through managed caresettings so they can learn how to see people in an "efficient and cost-effectivemanner." What's next—making widgets?

When young doctors go into practice, they are faced with a rash of decisions.Despite many articles addressed to this subject, most doctors still don'tknow how to effectively evaluate the deals that are on the table. Many ofthem are torn between practice opportunities that might meet their personalgoals (such as time off for education or family activities) and ones thatwill help them to get out of debt, or make more money in a hurry.

It doesn't truly matter whether this week's enemy of the private practicephysician is managed care, or a physician practice management company, orthe local hospital. What matters is that for many decades, individuals werechosen for medical school in part because of their ability to think andact independently.

We've now created a system where we expect these individualists to workcooperatively with others, especially people who might not have gone throughthe same educational process (nurse practitioners, physician assistants)but are often viewed as "the doctor" by patients, nonetheless.Our new systems, supposedly designed to root out inefficiency, often windup replacing one inefficient system with another, more massive bureaucracy.I know—I've run several medical organizations myself over the past decade.

What's to be done about this? We need to achieve a balance between technologyand personal contact. We need to recognize that one of the reasons peoplewillingly pay out of pocket to see alternative medicine practitioners isn'tnecessarily the herbs or manipulation or vitamins these healers offer. It'sthe fact that they listen to people, and make each patient feel he or sheis the focus of attention at that time and place.

Managed care is not going away, but physicians and organizations thatcan take a systems view of the practice environment and the needs of theircommunities will be better positioned for success. More and more accountabilitywill pass to physicians and patients in the years ahead, and those who haveaccess to information will be better able to manage that process.

So let's approach this coming decade in a proactive fashion. Put theadministrators on notice: Get them involved with us to design informationmanagement systems that are easy to use, that work for patients as wellas doctors, and that give us the evidence-based tools needed to offer thebest possible care.

Right now, it's impossible for us to weed through all the informationwe get on a daily basis from insurance companies, HMOs, physician organizations,professional societies, hospitals, pharmaceutical companies, governmentagencies, and so on. As a result, confusion reigns, and neither the doctornor the patient is satisfied with the outcome. There is nothing more frustratingthan a physician who doesn't know, or doesn't care to know, how to workup a simple problem; who refers the patient to a specialist (assuming themanaged care intermediary okays the referral), only to have the specialistsay, "I can't believe Doc so-and-so sent this patient to see me whenhe could have easily done this in the office himself."

A number of companies have jumped into the fray to offer informationbased on a PC or hand-held computer. In order to be successful, this informationmust be (1) evidence-based and validated, (2) category-specific (such asbeta-blockers post-MI) rather than product-specific, and (3) adaptable tothe unique environment of each practice setting. Anything that can be doneto reduce the noise and improve the quality of the information disseminatedcan only enhance patient care.

If we can achieve a balance of information and technology, and get agrip on the information that is available to us, we can then devote ourtime to what we went to school for in the first place—taking care of peopleand helping them to feel better. We've been given the opportunity to makea difference.

Each of us has to find out what's the best way to make that difference.We must realize that we and we alone are the masters of our own destinies.If we sit back and allow things to happen around us, we can't complain aboutthe outcomes.

As for me, I left private practice because I thought I could make a differencein another setting. After 10 years as a partner in a three-physician internalmedicine/gastroenterology practice, I became a medical director, first forBlue Shield of California and then for a network-model IPA. I then spenta rewarding two years with the Gila River Indian Community in Arizona, whereI helped plan and implement the shift of health services from the federalgovernment to a nonprofit organization.

I was fortunate to have the support of my wife and family, who all thoughtI was nuts to leave a busy practice with excellent income. They saw my passionand were supportive enough to allow me to try to reach my dream.

What I'm doing now, as chief medical officer for Software Pharmacy, is part of that dream. The goal is to take information, mergeit from various sources (pharmacy, lab data, etc.), and give it back tophysicians and other health care providers in a way that coordinates andthus enhances care.

As the profession evolves, I think doctors will chart a wide varietyof individual courses in an effort to fulfill their professional calling.At this point in my career, I realize more than ever that time is the mostprecious commodity; once it's used, I can never get it back. With that inmind, and in the spirit of the Medical Economics millennium survey,here are my personal and professional goals for the immediate future:

1. Take time to get to know my family and kids.

2. Take time to get to know my patients.

3. Take time to get to know my community.

4. Don't work myself to death. (Only the IRS benefits!)

5. Work intelligently. Use technology when it can help make my professionallife more efficient and effective.

6. Learn to work cooperatively with others. Take time to set realisticexpectations up front, so that I don't create an atmosphere where I'm doomedto fail.

7. Have fun. Don't be afraid to keep my eyes open and alert for new experiences.

I wish you Godspeed on your own journey.



Joel Brill. The challenge for each of us: Finding a way to achieve our best.

Medical Economics

2000;1:66.