In this ongoing series, Dr. Thomas N. Told, Dean of RVUCOM, shares his thoughts and experiences as a family medicine physician of more than 35 years. Each new entry will be that of a timely issue in the world of medicine, viewed through the lens of an experienced osteopathic physician and an advocate for improving healthcare services for all, especially those in rural and underserved areas.
Years ago, before the advent of online genealogy sites, my parents uncovered a picture of the Told Family Coat of Arms originating from Great Britain. The Coat of Arms was eventually embossed on a brass plaque and proudly hung on the wall for all of us to see as we grew up. The design was medieval in nature, complete with ornate flourishes. At its center was a large, intricate shield topped with a knight’s visor-style helmet on which stood a stag, its likeness replicated in the shield itself. Prominently placed at the bottom of the shield was an unfurled scroll with the Latin phrase: vitus fulo pretiosior auro, which I later learned means “virtue more precious than gold.”
As a young boy, I could not imagine why anyone would value a feeling or a personal trait as being more precious than a big pile of gold. As I grew older, it became clearer that there were many things in life that far exceeded the value of gold, to the point of being priceless and requiring extraordinary efforts to obtain. Over the years, I have grown to value that small piece of counsel from my ancestry. It helped me keep my standards high and put me on the path to be a good and productive member of society. In truth, I feel that most who are inspired to enter the healthcare field do so more for the satisfaction and sense of purpose that comes from serving humanity, rather than the remuneration or social recognition the field brings.
In today’s world, as we experience our newest battle against the novel coronavirus, we see daily accounts of healthcare workers pushed to the brink of exhaustion. Many more are putting their lives on the line as they risk personal infection from an unseen enemy they are desperately trying to destroy. In many cases, their physical exhaustion pales in comparison to the mental and emotional stresses that can wear away resolve and stifle personal resilience.
What drives these special individuals to undertake such risks for their fellow citizens, without complaint? It is seeing the fruits of what they have worked and studied for come to life to relieve suffering or reverse the devastating effects of trauma or disease. It is the desire of being granted autonomy to expand clinical skills and innovative endeavors.
Autonomy is the fertile soil that nurtures the spirit of discovery and innovation. By contrast, nothing can be more emotionally demoralizing and psychologically frustrating to any healer than to experience unnecessary impediments that force them, and their ideas, into the unyielding boxes of over-regulation (created by non-healthcare providers with other agendas).
I recently attended a discussion on physician burnout and suicide moderated by Alan Limbitz, MD, Chief Medical Officer for COPIC Insurance Company. Dr. Limbitz and I are colleagues from the days when we both practiced on Colorado’s Western Slope. He was based in the town of Granby and I practiced across Rabbit Ears Pass in Craig, Colorado. We both began to practice medicine in a time that many look back on as the “Good Old Days.”
In those days, injuries were just as severe, distances were just as long, and resources were just as limited as they can be today. It was hard work, but everyone had the feeling of autonomy; we were all united in a common purpose to deliver quality medical care in the vastness of Western Colorado. That collective feeling of purpose sustained us through long hours, endless overflowing waiting rooms, and seemingly unsurmountable systems failures.
In the communities we lived in, everyone from the local barber to county government representatives recognized and shared our same purpose. They appreciated our efforts and thoughtfully considered our input. They instinctively realized that their healthcare systems were only as strong as the providers in it, and we all needed to share the common purpose of building a strong, rural health network.
Over time, we have seen the corporatization of medicine, including the politicization of the healthcare payment systems. This phenomenon is especially felt in the urban areas where competition between hospital systems pits provider against provider. At the same time, third-party payers seeking greater profits and extended market shares trim their expenses by bridling providers with endless hoops of regulation to receive heavily discounted payments. This environment blurs the original purpose that physicians entered the healthcare field to experience, and it drastically dilutes any feeling of autonomy they had to improve the system.
An example of this trend of the corporatization of medicine is the evolution of the Electronic Medical Records (EMR). Once advertised to be the solution of delivering efficient quality healthcare, EMR has reduced documentation to a series of electronic dropdown boxes often containing canned (and, at times, inaccurate) descriptions of the patient visits. These features were first developed to save time but now require extra time to override the suggested response to make needed deletions and edits. If physicians are not vigilant in correcting these errors, they risk inadvertent and unintended medical liability, such as sanctions by state licensure agencies. Duplicating the work of documentation increases frustration and eclipses the real purpose for which the technology was developed for in the first place: to embellish patient care and ease the healthcare provider’s workload.
When I first started my practice, I was told by an esteemed colleague in the clinic that, for their first ten years, physicians practice medicine from books and in consultation with others. As they reach the decade mark, they begin to make more of their clinical decisions based on personal experience. Some refer to that transition point as a mastery of the profession.
One of the positive attributes of working in the house of medicine is that it is ever-changing and ever challenging to those who enter the many guilds within its walls. In truth, no person can know it all. It is for that reason that it has remained a practice for centuries, rather than an absolute science. When a physician masters the large number of skills and conditions in medicine, there is a calm reassurance and confidence that they can competently manage or solve most health-related problems. That feeling of mastery is not a proud or self-aggrandizing one for we know that, no matter how much we learn or how hard we train, there are still many more life lessons to experience in the practice of medicine.
According to Dr. Limbitz , in a large survey of physicians, there were three elements most of the respondents identified as being valuable and essential to a satisfying career in the medical field. Identifying and magnifying these elements could serve as a catalyst to bolster the enthusiasm of those who have become disenchanted with healthcare, even to the point of ending their own lives. These three elements do not include material wealth or more free personal time. They are autonomy, mastery, and purpose. Just as my ancestors discovered long ago regarding the great value of a virtuous life, the goals of autonomy, mastery, and purpose sought by most physicians today are more precious than gold.