500 Cummings Center
Beverly, MA 01915
Tel. (978) 927-8330
Fax: (978) 524-8890
Thomas J. Miner, MD
A 2020 resolution...
While trying to tackle end of year chores such as setting up my electronic prescription device to comply with opioid laws, reviewing IV Tylenol utilization for my Division, arranging to take a picture for yet another ID badge, and completing my tardy e-learning modules, I have felt particularly salty. No doubt, we all have similar tasks that we must complete. I know that I’m not alone in feeling frustrated, at times angry, and sometimes a bit beaten down by the escalating demands placed on us, as medical professionals, without a corresponding expansion of time and resources available. As so many have pointed out, we are increasingly asked to fulfil one more requirement, complete one more task, and accept one more demand on our time. Even though the reasoning, proposed benefits, and possible importance of each tasks may be individually justifiable (or at a minimum not worth the fight to oppose) the negative cumulative impact cannot be ignored. The impact of this trend has been increasingly used to explain problems ranging from decreased physician wellness to diminishing patient satisfaction.
In her New York Times op-ed "The Business of Health Care Depends on Exploiting Doctors and Nurses", Danielle Ofri describes the reliance of the medical industrial complex to maximize efficiency (and sustain profit) by relying on the “one professional resource that seems infinite and free: the professionalism of caregivers.” The author describes the cynicism and frustration many express as our professional ethic seems to be taken advantage of by a health care system that has become unrecognizably corporatized, regulated and populated with more administrators than providers. The system banks on the fact that hospitals are inspiring places to work and most clinicians will do the right things for their patients, even at a high personal cost. As surgeons, I believe this is a particularly difficult subject for us to discuss as some of the loudest voices speaking on these issues sometimes are incompatible with our professional training and disposition that emphasize service, hard work and selflessness.
Why do we continue to accept the current state of affairs?
I was standing in a line at the grocery store with my family during the Christmas holidays and a patient’s spouse approached me in an interaction that I know that my peers also often experience. He pleasantly mentioned that she had recovered from her major cancer surgery, was feeling better and was optimistically looking forward to the New Year remarking “I am so thankful that you saved her life.” Accepting gratitude is not always easy, acknowledging pride from loved ones sometimes even harder. It took me a while to recognize what a special opportunity I had been given right then and there. In my grumpiness over the messiness of current medical practice, I almost missed the gift that I just had been given. It would be easy to conclude my comments right here that our personal and professional lives would be better if we just valued and appreciated these special moments and remained grateful, motivated and inspired by the privilege we are provided. But to simply do so, I fear, is to fall into the trap that an unacceptable system counts on and ultimately perpetuates the “mission creep” that I believe threatens both our profession and patients.
I share a love of surgery with my friends, peers, and colleagues. Like many others I am both inspired and motivated by our work. Ultimately, this is why we meet, cooperate, debate and celebrate. Like many, I am concerned that current medical and surgical practice is not sustainable. This quandary is real and depends on our thoughtfulness, leadership and collaboration. We need to continue this discussion and come to meaningful and effective solutions for the good of what we love.
Thomas J. Miner MD