Can Professionalism Be Saved?

“Medicine has become factory work.”

“I would replace ‘burn out’ with physician ‘loss of control’ over the practice of medicine. The source of much frustration is that decisions are largely made by non-clinicians, because clinicians by and large are focused on actually caring for patients. Ironically, dedication to patients makes it so clinically-busy physicians aren’t at the decision-making table and if you aren’t at the table, you’re on the menu!”

Doctor respondents from the

 2015 Physician Stress & Burnout Survey Report

by Vital Work Life.

Physicians are in a precarious state.  According to the recent Vital Work Life 2015 Physician Stress & Burnout Survey Report, “Almost 66% of 2015 respondents said they were more stressed and/or burned out than in the 2011 survey.”  But as the quotations above suggest, burnout could also be another way of talking about the decrease in medical professionalism and physician autonomy.

While this blog has considered the problem of professionalism and patient experience from the perspective of the attending physician, it is also important to see how it affects graduate medical education and the teaching mission of the academic medical centers (AMC).

While there are many diagnosis of the problem affecting the teaching mission of the AMC, Let Me Heal: The Opportunity to Preserve Excellence in American Medicine by Kenneth M. Ludmerer and reviewed by Lara Goitein in the New York Review of Books (NYRB) is a good place to understand how the diminished commitment to teaching is both a cause and effect of the decline of the AMC and medical professionalism.  Ludmerer writes:

“In the era of high throughput…house officers found it increasingly difficult to act in accord with the traditional expectations of professionalism. In particular, it became extremely difficult for them to be thorough and attentive to detail and to make certain that their patients’ problems were recognized and addressed…. The patient volume was too high, the turnover of patients too great, and time simply in too short supply. Interns and residents in every specialty often experienced panic and anxiety as they struggled to care for far more patients than time reasonably permitted. The only way that they could cope with the high patient load was by cutting corners.” (Quoted in the NYRB)

The environment forces a deprofessionalization of the resident who then ultimately goes on to teach the next generation of doctors.

How is it possible for an individual doctor to maintain professionalism in a chaotic environment?  Is  professionalism an individual character trait or the result of a medical system which views doctors as machines who best leave the thinking to others?

Perhaps there is a new professionalism that demands collective action.

Dr. Scott I. Berman takes this questions head on in his recent opinion piece in JAMA “Gripers and Whiners.” Berman writes “Yes, medicine is more bureaucratic; yes, there are too many papers to fill out. But we have been trained as leaders, as the most highly competent decision makers. Giving in to bean counters at the expense of patient care is an abrogation of our moral responsibilities.”

Berman’s key point is that fighting this system cannot be an individual crusade but must be a collective struggle based on defending patients and quality care.  He writes:

“If we are going to be stressed and unhappy, at least let us take that unhappiness out constructively on those who would give our patients less than optimal care. It may be time for physicians to organize, perhaps even unionize. The goal would not be to line our pockets or demand minimum reimbursements. It would be to set minimum standards of care that we will not bend on. Suppose we were to tell hospitals, or insurance companies, that we will not do business with them if they don’t treat our patients right.”

Doctors Council could not agree more.