What is the one dumb thing you used to believe in?

I used to believe that if I did X, then I would have the answer to the world’s problems. If I became a neuroscientist, I would unlock the secrets of the human mind. If I became a doctor, I would understand how to fix healthcare. If I did X, then Y, my purpose in life, the answer would just arise, somehow, from my experience. (Along with fame and fortune, of course, but that was naturally less important).

What I’ve realized lately is that there is no real, one answer or even a defined set of answers to the world’s problems. That even as I gain more knowledge and experience, it only serves to deepen my sense of insecurity and ambiguity. That sometimes that feeling of not knowing and not being certain is the right place to be. That instead I should be thinking of ways to set my mind free, rather than to let it take a set path to a presumed answer, when there are so many perspectives and possibilities to embrace.

I’ve also realized that trying to live a life with a purpose, even in trying to write about living a life with a purpose as I have attempted with this blog, that purposes do not arise so much from directed action. Even if we do try and force a certain “purpose” to an experience, we cannot know whether that experience will really turn out to fulfill that purpose. Instead, we might gain something very different from that experience. This is a common frustration of program directors trying to organize meaningful clinical experiences and for students trying to seek the right experiences to make a compelling residency application. No matter what our best-laid plains might be, our purposes will always make more sense in retrospect, when we go back and look at the story of our lives. So rather than thinking that if X, then Y, I have come to realize, it’s far more important to try X — without any expectation of what will happen — and see where that experience takes me.

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However, I have been asked by others interested in what I do regarding how I manage my digital presence and the potential questions of professionalism on digital media. I don’t have answers for anything, but I did have the opportunity recently to take part in a MacLean Center for Clinical Medical Ethics discussion regarding the issue. Thankfully, the talk did not revolve around what indiscretions should not be shown on social media and how we should prevent them (though from time to time during the discussion these issues did come up). As I listened to the discussion, I realized that it raised several critical, unresolved questions that the medical profession would need to answer in order for us to move forward in shaping social media policies for students and physicians online:

• Is there a distinction between a physician on social media and a person that just happens to have an MD on social media? Obviously, since this is the internet, one does not have to brand oneself as a physician but can develop an identity based on whatever you want (though on the flipside, since this is the internet, you will almost always be found out for who you are). On the other hand, internet use is so pervasive, for everything from your high school classmates’ wedding pictures to managing your bank account. Should it still surprise the public so much that doctors might use it for their personal use? and that they might have lives too?
• Should professional education use regarding social media focus on “never events” or on more proactive online identity management? If the latter, what should that look like? This is the topic of most debates around social media policies, including the one at this ethics panel, and the conversation can quickly become far-ranging going from what defines a “never event” on social media (besides breaches of patient privacy) to whether or not the common sense of better social media use can be taught. These are all important questions, though they remain markedly difficult to resolve when people remain divided on the answer of the first question.
• How should doctors engage with informed patients or patients looking for information on the web? And how do we manage our time and the liability risk in doing so? We are still moving slowly from groaning when a patient comes into the office visit saying they’ve looked something up on the internet to encouraging patients to look into certain issues further online. Doctors are also starting to see the benefit of online communication as a way of keeping tabs on patients / answering patients questions without having to have them come in for an office visit. But the questions of reimbursement and liability remain big unresolved issues of the health care system.
• Last but not least, should doctors be on social media at all? and if so, for what purpose? Many others besides me have written about this in great detail, and a few points reiterated in the talk included a) that being on the internet was inescapable and b) it was, in some sense, where many-most of our patients are. Even the most social media skeptical at the talk were able to acknowledge that more readily-accessible, evidence-based online resources for patients would be valuable, but people were still skeptical whether direct, meaningful interactions with patients was possible over such an informal and public forum without violating HIPPAA somehow.

I don’t have the definitive answer for any of these questions, but I do think that until we develop some sort of a consensus on these questions, we will never have an ethics of social media use for the medical profession that makes everybody happy.

Further reading:

• Social media policies at US medical schools: one of the “seminal papers” on social media in health care, looks at actual social media use at US medical schools. Everyone is certainly online in some sense, but the presence of actual guidelines is rare. Even rarer — the presence of honest conversations about students regarding social media use.
• Medical Student Advocacy – Too Close to Home? my piece on Doctors for America on how with all the frowning on adult behaviors on social media, students might be also implicitly discouraged from speaking out about other things and engaging in much-needed political advocacy.

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1. How to Solicit Sex Ed Questions on Twitter

Every so often, someone writes a post talking about how physicians don’t actually earn as much as they seem due to medical student loans, or some story about how physicians are being forced into bankruptcy by their own personal choices or Medicare reimbursement changes. Especially with the current dialogue surrounding Occupy (your city here) and income inequality in the United States, I can’t help being a little skeptical about these claims, but then again, I’m no economist and so I have waited to see something that has numbers to back up their complaints.

Recently, I came across this article from Dr. Ben Brown has done a pretty decent job of summing up the issues with physician income. In short, our disadvantages are that:

• We spend an ungodly amount of time in training during our young adult years (6,400 hours undergrad + 15,360 hours medical school + 34,000 hours for a 3-year residency = 45,800 total hours).
• This time is poorly compensated – about $50,000/year for the 3-year residency (or $4.41/hr – LOL).
• And on top of that, student loans are terrifying. Assuming no loan repayment program, medical school alone tends to cost about $45,000/year (according to this article, to my knowledge, private medical schools are actually considerably more than that these days). At 7% APR (I guess this is assuming these are all Grad Plus loans or something) that comes out to about $200,000 in debt at medical school graduation (which is pretty much in line with other estimates of medical student debt).
• The tax code basically does not help doctors at all when it comes to repaying that debt: Since we tend to earn more than $145,000, physicians do not get to write-off loan repayments as a tax deduction, and for whatever reason, setting up a doctor’s office does not count as starting a new business (and so is not associated with the tax deductions that go along with that. Without getting into stuff like the SGR, basically, the federal government does doctors no favors for the work that we do, unless we work for a nonprofit hospital perhaps.

However, even considering all this, the article cites the 2009 physician compensation survey which finds that in 2008, primary care physicians earn $186,000/year and specialty physicians earn $340,000/year. According to Dr. Brown’s calculations, most physicians need to pay at least $40,000/year to pay back their loans after about 20 years (which seems like spreading out the loans quite a bit and doesn’t take into account loan repayment programs). This puts primary care physicians’ income at $146,000/year and specialty physicians at $300,000/year, pre-tax. According to the New York Times calculator, this puts primary care physicians at the top 10% and specialty physicians at the top 2% of the United States.

In my view, this puts physicians solidly in the “tax-paying rich” (aka much like Warren Buffett’s secretary, who earns his or her income from working and so famously, has to pay much higher taxes than Buffett himself). We’re not in the 1%, we’re not going to make any day traders jealous, and we work long hours and pay lots of taxes. But honestly? we’re still far from living in penury, we’re still better off than at least 90% of our patients (assuming an economically diverse patient population, which I realize isn’t always the case). What we suffer from then, ultimately, is not inadequate income but poorly calibrated expectations.

At the end of the day, we’re not becoming doctors to get rich quick (because what, exactly, is quick about medical school and residency again?) but to serve patients. QED.

Related posts:

1. Why Medical Students Should Get Involved in Physician Advocacy
2. Don’t Blame Medical Students for the Decline in Primary Care
3. Do Medical Students Need to Learn about Care Coordination?

As I wrote in my latest post on Doctors for America, there are many reasons why losing weight is difficult. Our bodies are built to preserve the weight we gain; so, even if we do succeed in losing a few pounds, we are biologically queued to do all we can to go back to the higher weight. Furthermore, fundamentally, as anyone who has ever watched the Biggest Loser realizes, the whole trifecta that leads to better health — weight loss, exercise, eating better — is not just a matter of hitting some short-term goal but a redefining of the environment that we live in.

As doctors and doctors-to-be, we often speak about “lifestyle change” as if it is something we can just write on a prescription pad or institute with a new health insurance policy, without breaking down the words and realizing that we are asking people to change their lives. We’re sweeping under the rug the fact that it is much harder to lose weight (involves eating much fewer calories and exercising much more) than to maintain a weight you’re already at. In the process, we’re stigmatizing our own patients for being lazy and weak-willed.

This unhealthy focus on unsustainable weight loss needs to stop. So, in my own quest for lifestyle change in order to achieve better health, I am simply focusing in on one thing: to develop a habit of exercise.

Here are five reasons why:

1. As a future physician, I want to know what I’m talking about when I ask people to change their lifestyles to promote their health. I can learn about the pathophysiology of disease in class, but I can only imagine how much each illness impacts the daily habits of those who have to live with the disease. I already barely manage to keep track of the few medications that I have to take as a relatively healthy 20-something, how can I know how each of my patient’s diseases affect their individual lives? This small change in my life is common enough compared to a new diagnosis of diabetes, but by taking small baby steps to change my own life, perhaps I will have some better sense of how to counsel my patients to change theirs.
2. By focusing on exercise, I am concentrating my energy on a behavior that I can change as opposed to a biology that I can’t change. As I alluded to above, the benefits of losing weight are rife with controversy, cultural biases and poorly-understood biology. How to we disentangle losing weight to be healthy from our cultural obsession to be thin and societal inability to acknowledge that perhaps everyone may have a different “healthy weight”? I’m still not sure how to confront all these issues for my future patients and myself, but I do know that the evidence that regular exercise is good for your health is pretty unequivocal. Perhaps most importantly, regular exercise is based on behavior that I can control rather than biological factors that I have no control over.
   
3. Given my current schedule, I am more sedentary than ever before, making exercise a greater need than ever before. I have never liked to exercise, but have gotten away with not exercising by generally eating healthy and staying active in my regular lifestyle. This was easy to do when I lived in a walk-up apartment, did not own a car, and walked to class every day. Now, I have a car, an elevator building, and instead of having time between classes and going home, I am in class for far too many hours a day to even think about going for a walk between activities (thanks med school). As a recent study in the American Heart Association’s journal showed, even when you control for things like what people eat and how much they exercise, every extra hour of sitting (to watch television) substantially increases the risk of cardiovascular disease and mortality. Therefore, I have to do something to counteract the amount of time I spend sitting in class and studying, whether I like it or not.
4. By making it a habit, I can insure that I actually make exercise into a priority. Medical school already comes with a pretty full schedule, which only gets worse as the years go along. Though I have seen classmates who enjoy exercise being able to fit it in after school or during lunch, I know that I would need to do something more drastic in order to fit something into my schedule that a) I’m not used to and b) I don’t like much. If I have to perpetually reschedule my exercise around lunch talks and evening meetings, it simply won’t happen. So, this night owl is getting up earlier every day just to make sure I make this new habit happen.
5. By focusing on this one thing to change about my lifestyle, I can better track my progress and ensure success. I’ve started reading Leo Babauta’s Zen Habits for inspiration in staring my exercise habit, and while I certainly don’t follow all of his advice on habit change, I do take seriously his admonishment to smart small and to start with one thing. I am one of those people who will try to do lots of things  at once and only get some of them done, but to change something that I have so much internal resistance on, I need to focus in and take this seriously. I may not be able to run a marathon at the end of the year or get any strength training in as a result of this, but I will be able to make a bigger difference in my life in the long run by making a more lasting change.
   

So, at least six days out of the week, I am endeavoring to get up early in the morning to hit the elliptical or (weather permitting) go run along the Lake Shore Path. I’m on my third week now, and I’m proud to say that I’ve only missed a couple days so far (one because we were going skiing, which I feel fulfilled my exercise requirement of the day and another because my alarm didn’t go off). Given how short my runs have to be, I don’t foresee this making a dent on my waistline, and there are no sign of any endorphins yet. However, I am already feeling more energetic on the days I do manage to get a good run in, and am slowly but surely seeing improvements in my cardiovascular fitness level / ability to run.

Further Reading (new section I’m adding for the new year because I hate doing link-only posts but there are definitely so many related links to share!)

• Weight Loss and New Year’s — my post over at Doctors for America, in which I go over some of the latest news on weight loss and reflect on how we should apply this information to treating our patients
• A Compact Guide to Creating the Fitness Habit — latest post on the subject by Leo Babuauta over at Zen Habits
• Weight loss posts from Dr. Jen Gunter’s blog — Dr. Gunter is an inspiration for many reasons, but one of those has been her public chronicling of her (evidence-based!) work at losing weight. She has lost 45 pounds in the past year, maintains a calorie count of 1400 a day and I think goes into the gym for boot camp and running multiple times a day. Along the way, she has shared numerous tips from her experience and the latest in evidence-based medicine on the issue. Quite the worthwhile read.
• Running out of excuses — great post from another one of my favorite doctor bloggers on her running inspirations and her own attempts of getting into running.
• Too Much Sitting is Killing Us — coverage of the Circulation paper on how watching TV increases cardiovascular risk

Photo credit: Stefan Lins on Flickr

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After all, one of the greatest rewards of writing is to be able to look back on what you’ve written and realize just how far you have come.

I am so much happier now than I was last year, so much more secure in my personal and professional relationships and so much more confident that I am capable of taking advantage of all that medical school has to offer. Though I have not actually thought about it on a consistent basis, I have been consciously feeling more grateful for the wonderful people in my life and the wonderful opportunities that I have had. While I am still putting together my goals for 2012, I have a feeling that my personal theme is going to take a little step back from the abundance that my work in 2011 has provided me and do more with the few projects that I do choose to focus on.

I am recognizing more than ever that being able to write openly and well is such a blessing. Over the past year, I have seen so many medical students feel obligated to write under pseudonyms or otherwise keep quiet about the problems they are facing in their schooling and in healthcare because they are being educated at an institution that does not take student feedback seriously or value transparency. I am realizing by reading their comments that I am incredibly lucky to be at an institution that does take student feedback seriously (and so I don’t have to take to the internets to give any feedback I might have) and an institution that does not take issue with me speaking about my experience with a medical student (so long as I protect patient privacy and do so professionally). I am eternally grateful for this medium that allows me to express myself while also providing something worthwhile for others to read and addressing issues important to the world as a whole.

As for my final resolution on striving to be healthy in 2011, for better or for worse, that resolution is continuing into this year and I am glad to see in this resolution, I am not alone among my medical student blogging colleagues. Stay tuned for my next post on how I will be developing an exercise habit in 2012!

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“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are at the twilight of life, the elderly; and those in the shadows of life, the sick, the needy, and the handicapped.” — Hubert Humphery, at the dedication of the Department for Health and Human Services Building

For the final keynotes of the IHI National Forum, we were treated to a speech by Dr. Don Berwick, former head of the Centers for Medicaid and Medicare and founder of IHI. Unfortunately, I was unable to attend due to my flight schedule, but I read the text of his speech afterwards and was struck, as he had been, by Hubert Humphrey’s quote above. That quote spoke to his desire to put patients first, especially his most disadvantaged patients who were not among the rich, white men that dominated decisions on Capitol Hill and elsewhere.

In health care, we have started to recognize that the disadvantaged are among those with the worst health outcomes, that perhaps we do need to devote more resources to “underserved medicine” from case workers or community health workers on the ground to a new generation of medical school graduates that are educated in health disparities and interested in doing all they can to combat it. There are programs that are even starting at the college level, connecting college volunteers with low-income patients to help with their psychosocial needs inside and outside of health care.

In our work to improve our healthcare system, I believe that we need to take this a step further. We need to recognize that the success of our health care system also rests on the extent to which it addresses the needs of the disadvantaged. As was reported in the BMJ Journal of Quality and Safety earlier this month, one of the many reasons why the United States is spending so much on health care and getting so poor results may be that we spend so little, comparatively on social services to help the disadvantaged. When the researchers included expenditures on social services, they found that the United States spent disproportionately less on social services (dropping from #1 in health care expenditures to #10 in combined health care and social services expenditures), and that higher life expectancy and lower infant mortality correlated most strongly with the countries that spent more on social services as compared to health services.

In the public health world, this should not come as a surprise. Last year, the head of the CDC published a pyramid for health impact that notes that direct patient counseling and education requires the most individual effort and resources while having the least population impact. On the other hand, socioeconomic factors and programs that address those factors have the greatest potential for having the largest impact while being relatively uncostly. As health care providers, we tend to work on the top of the pyramid. Even in the quality world, we agonize about ways to integrate behavioral health into the patient-centered medical home in order to address the need for individual patient counseling and education.

We need to move down the pyramid. We need to recognize that as health care providers who care about truly improving the health of our nation, we need to be helping those who can least help themselves. And that means recognizing and addressing head-on the social disparities and the lack of support in this country for the disadvantaged. To quote another principle put forward by Dr. Don Berwick: “there is no more time left for timidity…the time has come to do everything.”

Related posts:

1. Reflections on the IHI National Forum (Part II): It’s Not about the Money
2. Reflections on the 2011 IHI National Forum (Part I): Listening to the Patient
3. Alternative Medicine, Medical Education and Health Policy: An Update

I should note that this post is less a reflection of any hard data that I saw at the IHI conference but more of a qualitative feeling that I got listening to workshops and some questions raised in my mind that were reinforced by later reading/reflection and a service trip that I took to learn about rural healthcare in South Dakota. It is also because of said service trip that it has taken me so long to write this article. So, I’m going to just try and post up the rest of my reflections from the conference today so I get them out before the new year!

How often has the claim been made across the country that such and such an initiative that would improve the quality of care provide to patients was simply not possible because of the costs? That the incentives of the modern health care insurance system places far too much emphasis on the quantity of services provided and not the quality and so we will forever remain at the bottom half of all quality metrics among other developed nations?

Though not all of the changes some might like to see for aligning payment with quality are actually taking place, but there are a few real quality incentives on the way or already being implemented with the new healthcare reform. However, when I saw them being discussed at the Institute for Healthcare Improvement conference this year, I couldn’t help feeling that these “new” monetary incentives will continue to have a relatively minor role in improving quality. Whether they’re incentives to implement a new kind of technology (like the new health IT funds for implementing meaningful use electronic medical records) or even a new kind of healthcare delivery system (e.g. accountable care organizations), they will hardly ever raise the bottom line enough to justify the cost of implementation — unless quality is already considered part of that health care organization’s bottom line. As a recent NEJM editorial points out, though there is no association between better quality healthcare and higher costs, that also indicates that higher quality healthcare systems do not necessarily lead to lower costs. For the most part, the quality improvements commonly discussed — reducing hospital readmissions, improving provider efficiency — will not lead to lower bottom line but an increased capacity for the organization. Therefore, the actual cost savings for the organization (and at times the system as a whole) may be modest despite the upfront costs of implementing the changes in the organization and the changes in the quality of healthcare provided to the patients themselves.

So I would not be surprised that even if Medicare is providing some incentives to fulfill the hospital quality metrics, like being in the top 50 percentile in patient satisfaction, that many hospitals will not bother since their hospital is simply not configured to collect and quickly respond to patient input in a way that is really able to improve patient satisfaction.* Yet as I spoke to people working in regional healthcare systems during my service trip to South Dakota, I found hospital leaders that were taking their patients’ input seriously in redesigning whole floors of their hospital because it is supported by the new Medicare initiative and also because it’s “the right thing to do.” It’s common for us to gravitate towards some new change in the healthcare policy landscape as a reason for a change, but at hospitals like the one I was visiting, the infrastructural change that they implemented (complete remodeling of the patient floors to make a quieter, more comfortable hospital experience) had to have been planned long before the Medicare regulations were finalized and relied on a department of patient advocacy to collect and determine how to respond to patient input that had been in existence in that hospital, under various names and departments, for decades.

In other words, speaking further with the hospital leader who was giving the tour, that hospital had a long-established culture that supported efficiency and accountability in its staff. More strikingly, as a regional hospital in a mostly rural area, they are far from as well-resourced as some other places, with a predominantly governmentally-insured population (Medicaid/Medicare/Indian Health Services) and physically distant from many of the academic and cultural centers found in major cities that would draw the best of the best physicians. Yet, if I may idealize their example for a moment (not knowing other regional centers and with only very limited knowledge of even this one), they seemed to have a staff and leadership (including a community-elected board) that really seemed to care about serving their community as a whole, and so from the very beginning, the extent to which they were providing quality care to their community was already a consideration in their business planning before any financial incentives from Medicare were implemented to encourage such behavior.

Unlike financial incentives, culture is hard to quantify and even harder to disseminate. However, after my experiences of the past month, I can’t help feeling that it will be a far stronger driver for improving healthcare quality than all the financial reforms being passed down through the healthcare reform bill.**

* Many may even go so far as to say that patient satisfaction is not a metric that should be focused upon since it is based on the arbitrariness of patient opinion rather than any patient knowledge of how good their care actually was (because what do patients know anyways?) I won’t dispute whether patient satisfaction is an objective or subjective measurement (subjective, clearly) but I would point out that focusing on patient satisfaction does first and foremost force the healthcare institution to listen to their patients’ commentary which is an important step in of itself.

** That is not to say that the financial incentives are not helpful or can be detrimental if not aligned with quality. Just that they are ultimately only a part of the story.

Related posts:

1. Reflections on the 2011 IHI National Forum (Part I): Listening to the Patient
2. Reflections on the IHI National Forum (Part III): The Moral Test of Health Care

As I sat down to write up my thoughts from the IHI National Forum, I realized that it was far more than could be adequately covered in one post (unless said post was incredibly long), so I’ve broken it out into a few posts – Enjoy!

I can remember after one of my first patient encounters, I was still a first year medical student who had barely learned how to take a history, let alone a physical exam. With a few other medical students, I was driving home from a medical-student run free clinic and one of the other volunteers was saying, “I can’t believe I didn’t realize that woman was depressed.” I admitted being surprised as well. It was totally unexpected and not in her chart, even if for the patient it was something that had happened before. However, I remember thinking that we shouldn’t have been beating ourselves up for not knowing — because that is why we needed to ask, and then listen to the patient’s story.

Related posts:

1. Reflections on the IHI National Forum (Part II): It’s Not about the Money
2. Reflections on the IHI National Forum (Part III): The Moral Test of Health Care

I’ve tried all I know for relieving stress to try and make things better:

• Yoga
• Taking a mid-week breather to spend time with my boyfriend
• Minimizing the importance of obligations so they’ll seem less daunting
• Freaking out about how much I’ve someone convinced myself is going to get done in a 24 hour period, and then pretending it does not exist and just going to bed (or playing video games, or going out, etc.)

(For those of you taking psych right now, as I am, you might recognize the progression from the “mature defense” of sublimation down through neurotic rationalization and intellectualization with a little denial thrown in there. I promise that none of this has sufficiently interfered with my normal functioning to be considered pathological — I think.)

It’s just a little too much with much too little of a break from the summer. It’s the shortening of patience and depletion of energy that comes with constant stress that even one stolen weekend of no work and studying (which you know will screw you over for the week) will not solve. Things have to be let go. I need to be able to let go. But what and how when there is so much?

So I turned to my private journal (which is not this blog, believe it or not) and I let myself write. I pulled out some unfinished prompts from the old Joy Equation and I thought about what I really wanted for the future. I thought about what I was grateful for and what I was excited about. I thought about my own personal narrative and how with all the things I am and have been involved in, maybe I have let it get too complex and overreaching, even for my own self.

I remembered that who I am needs to be more than just the sum of parts.

I realized the tension in my values between making a difference in the here and now but also setting up slow steps for the future of improving the quality of health care for all. I recognized that I needed to pull in and commit only to those core activities that define me — strengthening my core competencies in doing community work and doing what I can to advance that work within my university in a compassionate and quality-driven way. I saw that while I loved evidence-based research and physician-driven advocacy that (at least for now) these would never be my life’s work. Instead, I found in myself a desire to want to build local systems changes and patient advocacy — still new, scary worlds just outside of my current reach but it takes naming a goal to know you need to take steps towards it.

Finally, I realized (what perhaps should have been obvious from the start) that in order to do any of this, I need to prioritize being the best student that I can be. Because I can’t take care of patients until I know basic pharmacology.

(In some ways, that has been the best and the worst part of second year so far. Pharm has been for me the line between interesting knowledge for some advanced undergraduate or medically-inclined biochemist, but true medical knowledge that in some ways no one would bother to learn or memorize except for the inescapably real fact that this may help a patient someday.)

It’s hard work sitting down and realizing your own narrative. In the end though, the measure of peace it brings is worth the time you’ve taken away from neuro studying, chores and other projects. Because you, like each and every one of your patients, is worth that extra moment to make yourself feel whole.

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You may have seen me posting from time to time on Doctors for America’s blog Progress Notes. I have recently been promoted to a monthly contributor! Don’t worry readers, I will still be posting my personal reflections here, but saving some more wonkish thoughts to engage in the discussion there.

Here’s a snippit from my first post as a regular contributor:

We dream of patient-centered medical homes – perhaps your clinic is even in the process of implementing one. We talk about nurse care mangers and patient navigators – perhaps your clinic even has one or refers to such a service. Nevertheless, in actual discussions of how we address patient issues now, the ultimate responsibility seems to still fall upon the doctor to try and figure out how to fit everything into the twenty minute visit.

Are we still so cynical to not truly believe that change is coming? Or is this more deeply rooted in our tendency to place the doctor-patient relationship at the center of all health care? There are justifiable reasons for why we might want to say “yes” to both of these questions: change is slow, resources are limited, and no matter what changes are made the doctor-patient relationship is still very important. However, if we are to move forward into the future of health care, we need to all acknowledge our biases and understand how they shape our discussions of what health care will and should look like.

For the rest of my post, check out the Doctors for America blog here.

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