Monday, July 29, 2013

Divided We Fall

The question that incessantly tugs at my gut is," when will we say 'enough'?" I have the good fortune to interact with physicians across our nation. What is stunning is the commonality of our experiences, frustrations, and fears. Nearly everyone echoes the same sentiments. We are downtrodden by the yoke of our loss of social and economic standing combined with an overdose of unnecessary and crippling logistical constraints.
Regarding the former, doctors have been subjected to an apparently intentional diminution of stature. Most obviously we are no longer "doctors"; instead, we are a mere segment of the blurred gamut called "healthcare practitioners". Within this array, physicians represent an oftentimes indistinguishable part. What happened to the time-honored concept of the doctor as the "general" with others in the medical field occupying the lower ranks along the hierarchy of expertise and concomitant responsibility? This militaristic construct was not born of abuse or cruelty to those below; it was a system created to guarantee that ultimate accountability lay in the hands of those most capable. And it ensured that physician extenders such as nurse practitioners and physician assistants -- excellent and integral deliverers of healthcare -- would always have the guidance and support of physicians, people with greater training and clinical expertise. More subtly, but equally disturbing, has been an erosion of hierarchy among doctors themselves. We have been commoditized. Our insurance-driven economic equalization has led to the notion that one cardiologist is as good as the next and every surgeon is equal to another. Of course we all know such a belief is absurd. Some surgeons tie knots around their colleagues; and superior cardiologists hear even the faintest of murmurs; while a few can barely hear anything at all.

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