Recently, a group of representatives from the health-care industry met with the president to discuss changes they were willing to make to decrease costs.  Oddly, no one asked me anything, nor did they ask any of my partners, about how to accomplish this goal.

More and more, as the years slip by, I feel as if we physicians have surrendered our influence.  Consultancy firms convince hospitals of necessary changes; time-outs, for example.  When physicians explain that they have systems in place that work, they’re treated like children.  ‘Sure, you have that system, but it’s dangerous and ours is better.  Now you do as we say, keep taking care of the sick using our system, and we’ll call you later.  We’re going to dinner!’

Administrators, well-meaning and often talented, can only see the distress of the system from the narrow view of the spread-sheet.  ‘Looks OK from here!’  Physicians may be crushed by uncompensated debt, inadequate staffing, insufficient and exhausted nurses, overwhelmed facilities, inefficient systems, archaic divisions of labor or new and ridiculous ideas for safety (for example, the idea that physicians aren’t capable of checking hemoccult cards for rectal blood!).  But when we say it, unless we are academics, policy-makers or holy Hades-raisers, the consensus is frequently that we really don’t have the right perspective, that we’re difficult, we’re whiners, we need to just endure and deal with it all.  The powers that influence systems walk through the department, shake their heads, take notes and move on.

Take, for example, the average emergency department.  Often crushed by holding patients, psychiatric patients, patients sent from someone’s office because they ‘just need to be checked before they get admitted,’ patients waiting on lab results that should have been done faster, radiographs that could have been read more quickly. And yet, the flood of patients goes on unimpeded, the administrators sorry but unimpressed by the numbers (but concerned about the complaints and Press-Ganey scores), the staff of physicians and nurses weary and quickly used up.

I know it’s true.  Not only do I practice, I write a national column in Emergency Medicine News  (  People write to me.  They tell me things.  They take me aside at meetings and whisper the awful truths of what they face as struggling physicians.  The way their viewpoints are considered moot because all they do is patient care.  Because their honed skills as diagnosticians and proceduralists don’t bear enough weight compared to the immense value of physicians, nurses and others with MBA’s or positions of real authority.

What does it matter what I think?  I’m only a physician. I’m only exhausted, trying shift after shift to do the right thing, to burrow my way through waves of patients, and argue my way through layers of consultants in order to accomplish what needs to be done.

I’m only a practitioner.  What do I know, compared with the real world of numbers?  What does the government care about the physicians who are too busy to be advocates?  Who cannot meet over lunches in Washington? Who don’t have the ear of the elite?  Whose political viewpoints render them irrelevant, since they are not doctrinaire supporters of single-payer systems, reform and rationing?  Since they are not doctor-blamers?

We have sold our souls, or given them away, or had them ripped from us.  We physicians have done a fantastic job of caring for the sick and dying; of focusing on the work at hand and our lives at home.  But in the process, we have become cattle to be used; sheep to be shorn.  We have become the unwitting bearers of a system grown so inefficient from the machinations of those distant from patient care that it will soon collapse, only to have the collapse blamed on us.

What’s a doctor to do?  After all, I’m only a doctor; I’m only a worker-bee.  And I don’t see ‘the big picture.’  The numbers are what matter.

Oddly, we physicians, too, are little more than numbers.  And I’m pretty sure that as reform marches forward, we won’t matter at all.


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