Saturday, September 27, 2008

Who Killed Healthcare?

Healthcare in America is not dead.  It is critically will not die, because it is the basic stuff of life....not to be denied. Darwinians know that the strongest survive....both as individuals and as a species.


No one is writing 'DNR' in the chart nor on the forehead of our unconcious,  but not  quite vegetative patient.

Maybe we all can resurrect our patient with miracles, and teamwork.....A medical home for healthcare, and not just for patients. What do you think it would take.....I've been doing it for 40 years, and don't pretend to know an answer....Most of my colleagues have been doing it a long time as well....ask them and you will receive a litany of answers.....Most have been too busy surviving their patient load,

trying to run their business, and hopefully having some time for families. On the surface we all seem composed, imperturbable, and equanimous, however under the surface all the frustration

and anger, managed hundreds of times a week take a toll.  There are few patient encounters that do not stumble into some bureaucratic or regulatory mechanism. Many physicians have divorced, lost their family and have become alienated from normal society.  Many know no other way of life.

Race horses are bred and raised to race

.....that is what medicine is like...a race from the time you enter college or medical school.

Race for grades, race for internship and post graduate training, race to set up a practice, race to keep current, race to keep up with paradigm shifts, avoiding lawsuits, somewhere along the line the younger race horses catch up and pass you...You are put out to pasture, find an administrative position, or worse,like the race horse in the pasture dwindle and die.

  Some of us begin writing, and also attempt to mentor or nurture young colleagues, not so much in medical wisdom, but the sort of wisdom from an older colleague who has been through it all.

  I like to compare this to McCain vs. Obama.   Things like how to judge character, how to have integrity, and not follow the crowd. How to say NO!  The older warrior who can dip from experience, both successful and more important, failures.

Young achieving professionals are bent on proving how right they are, fearing a failure will mark them as unsuccessful.  Old warriors have lived and done it....are not preoccupied with demonstrating how right they have been, nor fearful of demonstrating their lack of failure.

A big change that I noticed about ten years ago is that despite my own relative youthful attitude I could not advise younger physicians because my world in medicine was so different. I needed to dip into their lives, professionally to see how they related to the new system.  I could attempt to advise them on being a good and moral person, to set priorities, and what success really means.  Often when I spoke to residents as I pontificated, their eyes would glaze most young people...they would wonder what I was talking about.

Americans have never failed to overcome crises, it is the best part of us.....not our government ,but our people. 

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