Lemons to lemonade: Why I remain in practice

Just looking at this makes me depressed,” says one of my partners as he laid down the recent edition of the medical newsletter announcing the latest details of Medicare’s meaningful use requirements. I, along with just about every physician I know, could certainly relate to how he felt. We all face spiraling decreases in reimbursement; continued unfunded mandates requiring us to expend money and increasing time on initiatives without proven value, and upgrades (I call them downgrades) to our EHR [electronic health record]that mean more time entering data in ever- greater detail that most of us feel benefit neither our patients nor us.

We are portrayed in the media as being incompetent, money-hungry, uncaring, arrogant, all the while walking around with targets on our back for the ever-increasing number of trial attorneys looking to cash in the tort system of medical malpractice.

Hospitals and insurance companies, not to mention state and federal agencies are dictating more and more how we practice medicine, and we, as a profession, appear impotent in altering this process. As I heard someone say, “They keep torturing us, and we have nothing left to confess.”

Truth be told, we bear at least some of the blame for what has happened to us. Through lack of our involvement, the organizations that are supposed to represent us no longer do, as they were co-opted by small groups of entrenched medical politicians and administrators more interested in maintaining their well-paying fiefdoms than leading us toward solutions.

We have also done a poor job of policing our own ranks by allowing the establishment of a legal system that makes it almost impossible to weed out the bad apples in our ranks without incurring costly litigation and high personal liability.

We have also allowed outside forces to pin the blame on all the ills in the system directly on us, rather than those who have been garnering the lion’s share of the profits in the healthcare pie: the insurance companies, the pharmaceutical industry, and the IT and health equipment industry.

Notice, there has been no government intervention to rein in their profits, though they account for almost 70% of  healthcare expenditures.

The paying public should be given a bill that reflects the true allocation of costs. For example, that $100 aspirin bill they received while in the hospital should state: cost of aspirin-$0.05; cost of meeting Joint Commission requirements to dispense aspirin-$35.00; cost of uncompensated care hospital is required to provide by law-$30.00; cost of meeting unfunded state and federal mandates-$34.95. Then patients would better understand where their money is going, and who is responsible.

Change is inevitable. Buffeted as we are by the winds of change, I remain optimistic that as long as there are those of us who can remember why we chose this career in the first place, our profession will survive.  

I have reached the age where I have relaxed fit skin to match the clothes I wear, and I continue to practice, despite all the frustrations I share with my partners, as well as the rest of you out there, not to maintain my standard of living, but because I love what I do. I was fortunate to discover a long time ago the wisdom in Winston Churchill’s statement: “We make a living by what we get. We make a life by what we give.”

Next: 5 ways to keep morale high

Here, then, is the prescription that has worked for me, and hopefully, will do the same for you:

•  The biggest payoff I’ve had in medical practice has been my relationship with my patients. We in medicine are given an incredible gift-the immediacy of a relationship with another person, with a lot of the veils that many of us cover ourselves with lifted. If you take the time to ask your patients to share their stories with you, you will discover some incredible tales of heroism, pathos, love, and history.

You will be changed, as I have, by dying patients who have taught me about dignity in the face of indignity, about courage to fight battles no one knows how to win, about the power of hope over despair, about grace and the strength of the human spirit. I’m reminded daily to live as if I am dying, for none of us finish this ride alive, but appreciating the ephemeral nature of our existence helps to focus our attention on all that is good and beautiful around us.

I have a patient, 96 years old, who still lives by herself, drives her own car, sends me e-mails, has a wonderful sense of humor, makes the best lemon cakes ever for my wife and I on our respective birthdays, and gives me hope for the future. Doing something well means caring about the person for whom you are doing it.
 

• The other reason I still work at this stage of life is I enjoy learning something new.  One of the gifts of our profession is that you can never get bored. There are so many new discoveries, so many advances each day that it’s hard to keep up. That’s the reason I’ve been involved in teaching medical students and house staff for the past 38 years. There is no better motivator to keep up in your field than the stimulation that comes from teaching someone else.

If at all possible, become involved in teaching, if not in a formal program, at least in your hospital. Teach your nurses, your colleagues, your staff, and you’ll find yourself learning the most of all.

•  Live below your means. If you don’t spend to the maximum of your income, if you don’t carry debt, you won’t feel anxious when reimbursement falls, and feel pressured to see more patients to keep afloat. It’s hard to enjoy a patient encounter when you set a five-minute limit on the visit.

•  Get involved with your community. We have all been given great gifts, and the rewards that come from giving back to others are immense. We all have the opportunity to add a few threads to the texture of the world. Make yours more beautiful!

•  Form your own physician support group. We all face similar challenges, share similar frustrations. In my community, we try to make it a point to get together once every month or so over a meal, and talk about our issues. We vent, but also attempt to come up with solutions to problems within our own hospital and offices. I can’t say we have been successful in each instance, but sharing the load has lightened the burden.

In her book God Never Blinks, Regina Brett observes: “Happiness is not getting what you want. Happiness is wanting what you have.”