by Richard I. Levin, MD — President and CEO of The Arnold P. Gold Foundation
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness…” So begins one of the most famous books in the English language, Dickens’ A Tale of Two Cities.
For the past few months, I have been traveling the country speaking at various venues to doctors in training and to doctors in practice. It is the duality of these experiences that has led me to recall Dickens’ opening lines. It has been gratifying speaking to joyful medical students and their mentors as they are inducted into the foundation’s Gold Humanism Honor Society, eager to start their careers in medicine and so full of desire to provide the best, most humanistic care to their patients. In stark contrast, my speaking engagements with doctors in practice have been disturbing. Their disappointment is palpable. Pushed to see an increasing number of patients in a shorter amount of time, forced to spend precious hours “charting”, regulated by everyone including their own specialty organizations, their careers are not what they had imagined.
Although our work in academic medicine is not done, over the past 27 years the foundation has made great strides in raising awareness about the “hidden curriculum” in medical school and residency. It is the dark side of the “hidden curriculum,” the incongruous nature of what medical students are taught about compassionate care and the lack of it displayed by some of their role-models, that sows the seeds for the meanness so often experienced in current patient care. We will continue to work to eradicate this situation and to support research and programs that teach the value of balancing clinical excellence with kindness, dignity, attentiveness and compassion.
But while we have helped change the face of academic medicine, making humanism in medicine the clarion call for a generation of medical students, and as we begin doing the same in nursing schools, we must also begin to concentrate on physicians currently in practice. In the most recent issue of our newsletter, DOC, we featured a reprint of an important New York Times article. “Who Will Heal the Doctors?” which provides valuable insight into the demoralization of physicians as they are caught in the bureaucratic nightmare of an increasingly corporatized healthcare system. The contrast is stark. Back in the day, the “apparent curriculum” of the practice of medicine was about patient care; challenging cases, discussions with colleagues about symptoms, diagnoses, better treatment options. So often now, discussions focus on incompatible and inadequate electronic health record systems, reimbursement issues, lack of time to spend with patients, and early retirement due to physical and psychological burnout.
This shift is critical because doctors who are demoralized and experiencing burnout at unprecedented levels cannot provide the compassionate care that results in the best health outcomes and better patient experiences that lower costs. While each transition from the study to the practice of medicine has its unique disappointments and trials, the ranks of physicians unhappy with the current state of practice has swelled dramatically. In a recent study of more than 5,000 physicians, 9 out of 10 respondents were unwilling to recommend health care as a career, with 43% also contemplating early retirement in the next five years. Coupled with the increase of new patients entering the healthcare system as a result of the Affordable Care Act, we approach a perfect storm that, without intervention, will lead to a spiral of declining function. Neither patients nor practitioners are happy with the current limitations of a system that does not allow for the development of a trusting, compassionate relationship.
The Gold Foundation wishes to play a unique and distinct role in helping today’s 800,000 practicing physicians reconnect to those aspects of caring that initially made them want to enter medicine. We are convening a national Task Force of practicing physicians to help us determine how we can best support physicians in their efforts to enhance health and maintain their humanism in the current healthcare environment. Currently in the planning phase, we will launch The 800 Project by the end of 2014. Not a moment too soon.