Embracing Discomfort

Artist: Iván Tamás

Embracing Discomfort


Hear from the publisher about the articles in this issue and the importance that they hold. Learn more about the writers in this issue and the reasons that they were chosen to contribute, and learn more about the important issues such as healthcare and consent.

The most important piece you will read in this month’s issue is the one written by Jade Robey. This impressively mature high school student plans on following in her mother’s footsteps to become a physician. In her eloquently written piece [1] “Lost,” Robey puts into words the disconcerting feelings that so many of her generation have experienced during the isolating pandemic. She lost an important year of her life but gained a perspective that many of us have yet to realize. She remains undeterred in her conviction to become a healer. It is for the future of medicine that Physician Outlook exists. We need more “Jades” in the world.

The rest of this issue of Physician Outlook is full of content that purposefully challenges you to question the “status quo,” to make you squirm, challenge your assumptions, re-frame your mindset.

As a physician turned publisher, I have come to understand that the only way we can meaningfully solve problems in healthcare is by first listening, and then understanding one another’s perspectives.

“A rose by any other name would still smell as sweet.”-William Shakespeare

Eric Starkman’s use of this provocative title for his article “[2] The Dangers and Deceit of MD Lites” could be construed as a form of “clickbait” that was likely intended to entice the unsuspecting peruser to read his article. It worked for me.

“MD Lite” is not a ‘sweet’ sounding term for the members of the healthcare team currently known as Advanced Practice Providers (APPs), who were formerly called ‘mid-levels’ or ‘physician-extenders’ (both of these terms are now considered derogatory).  I personally prefer the term “Non-Physician Provider,” or “NPP,” a term that I first learned of when I became a dues-paying member of Physicians for Patient Protection. APP’s include Certified Registered Nurse Practitioners, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, and Physician Assistants.

I came across Starkman’s amazingly refreshing website precisely because of the title, and while I do not condone nor use that particularly sensationalized term of “MD Lite,” I sincerely appreciate the fact that a layperson such as Mr. Starkman “gets it” and is doing his part to unabashedly educate the public.

Changing one’s title to “Physician Associate” from “Physician Assistant,”  or using one’s non-clinical ‘doctorate’ (PhD or DNP) to identify oneself as a doctor to a patient is disingenuous, yet the practice is being promulgated by the administrative hospital and insurance “suits” and the influential powerful lobbying organizations that line their pockets. As we can all agree and attest to, Advanced Practice Providers are extremely important parts of the medical team, but they are not physicians. They don’t have the training of physicians, they did not go to medical school.  It is downright deceitful to pretend that they are.

FOLLOW THE MONEY.  

We are currently operating within a healthcare milieu that prioritizes saving or making money while paying lip service to patient safety. We reward C-suite executives (including physicians) to earn ridiculously generous salaries and compensation packages. We hide the fact that over 80 cents of every healthcare dollar spent in the US is spent on administrative overhead. The layperson likes to blame “the doctors” for over-ordering tests, prescribing unnecessary and expensive medications, missing crucial diagnoses, etc. but that is not the whole truth.  It’s complicated and crucial that we stop and listen to the brave whistle-blowers and honest reporters like Eric Starkman, who take complicated issues and break them down so that we can understand them. One of my favorite whistle-blowers and noise-makers is Dr. Marion Mass, who Starkman recently highlighted, noting how “she doesn’t mince words about healthcare professionals who anger her, even if they work at big and powerful institutions.”  This issue contains her powerful article titled “[4] Medicine’s Sell-Outs (Scrubs Gone Wrong),” where she bravely calls out the behaviors of some of the C-Suite doctors in “suits.”  We, physicians, have plenty of ‘dirty laundry’ amongst our own ranks, including the bullying highlighted by Dr. Adam Harrison in the article on his journey from physician to leadership coach

Dr. Robert Pearl is another one of those doctors who have been brave enough to speak out about some of that soiled laundry in his latest best-selling book “UNCARING, How the Culture of Medicine Kills Doctors and Patients” [5] (the inspiration for Alyssa Dean’s piece on the future of Public Health in the current issue). Pearl undoubtedly bruised the egos of more than a few physician colleagues by pointing out that the ‘prevailing physician culture often breeds a hierarchical sense of individual exceptionalism, heroism and invincibility, which often clash with the individual doctor’s sense of status and control.’  He also offers some solutions for what he believes the future of medicine should look like, and how we change that culture. He recognizes the importance of preventive care and the role of the primary care physician, who has always been undervalued in our current culture of medicine. However, while Pearl’s Machevelian vision for “broadly available, prepaid, integrated, high-quality healthcare” sounds good on paper, we FIRST need to clean house and demand transparency about those currently in charge of the current healthcare cartel.

The collusive relationship between the layers of middlemen that stand between physicians and patients needs to be fully transparent before we turn over the keys to the castle to this “broadly available healthcare” that Pearl predicts will be the panacea for our ailing healthcare system.

We need some common sense to return to the practice of medicine. Patients need to be an essential part of the equation and taught the value of improving and maintaining their health to make sure that physicians and health systems do not get punished for their poor personal health choices. This will take decades and will involve much-needed reform of agriculture and education policies that have ALSO perversely incentivized profit over the individual citizen.

It’s time to re-think EVERYTHING.

 

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