Physician Outlook

An Ethereal Rant

The author poignantly describes an introspective day in the life of a mid-career physician. The bureaucrats can try to replace us and chip away at our autonomy, but the patient-physician relationship remains strong and will not be interrupted.

It was a moment.


I held a hand today.


She was nervous, understandably, as many patients are. She saw that I was tired and I saw that she was scared. I had been a patient well before my role as physician. So, we shared a nuanced understanding of this experience -- one of vulnerability, trust and hope. Although the foundations and history of the doctor-patient paradigm are ancient, here we are, under the vault of the same heaven with the same humanity, today. Here, we are at the same moment, time-sensitive, yet, timeless. Human nature is what it is, encumbered with human suffering and frailty.

She was not wearing a mask at the time. Neither was I. So, there we were: unmasked yet undaunted. In all that, all that was needed was a moment and a held hand. Sometimes, the most simple things are the most powerful and profound. For those of us fortunate to live a professionally clinical existence, it is authenticity that keeps us most grounded.


I held a heart today.


As I sat for a moment, I appreciated how caring her nurse was toward her. Until a few moments ago, she could have been just a name on the schedule, absent of the context of her life and what she means to those that surround her. She was there for care, despite whatever diagnosis, prognosis or outcome may await her; and, her humanity remained intact. I saw hope in her.  I saw heart in her staff. I saw the better angels in a burdened system, a system that is actively and unrelentingly burning out the workhorses, at times with reckless abandon. Despite the checklists, production pressure and overtures for the impression of efficiency, she was cared for with sincerity.  Despite a system that is evolving and administratively top-heavy, it is still anchored by strings of heart in these good people.


I held a mind today.


Yes, I noticed. I notice my generation. I notice we are face-mask deep in a conformational paradigm shift in the practice of medicine. I noticed how the generations before me deserve my respect and care, and how they need us. Despite their flaws and mistakes, we owe them. The fact that some of the net effects of our generation is not without blemishes is utterly inescapable. I notice how the generations after mine are capable, savvy, talented and impressionable. I notice the peril that could come as technology outpaces morality. I worry for a system whose clinicians were formed during a time of rampant corporate sophistry, in the fog of unrelenting narratives and the litany of clinical buzzwords and acronyms. Indoctrination can become its own handicap…or, it may go unnoticed entirely…whichever is more tragic remains to be seen.  Will they be able to see through the fog should those days come?


I held an eye today.


Although we willingly entered a service industry, I watch the attempts to affix a blue-collar to our white coats and profession. I watch as they refer to patients as customers, or the attempt to redefine us all as “providers,”  although I never went to provider school. I watch them try to equilibrate providers of various levels and years of training, essentially, trading a genuine, collaborative dynamic for a competitive one. I watch the net effect of this strategy undermine the teams I rely upon.  When the dynamics are aligned, hierarchies in teams are natural, effective and necessary. I watch them attempt to superimpose and retrofit a corporate ethic upon a medical ethic. I watch, as it is lost upon them, that one cannot commoditize providers any more than they can legislate talent, technical proficiency or clinical ability. I watch, as should we all, attempts to undermine physician autonomy and the integrity of the doctor-patient bond. Of late, we’ve had to watch politicians play doctor, administrators play provider and doctors play celebrity. These eyes have beheld interesting times, and we are not yet finished.


I held a tongue today.


It was mine—sullen and circumspect. Weighed down by the trenches of clinical medicine and the cascading narratives, we all tire. Fatigue is an inevitable consequence and “burnout” has become a cottage industry. I appreciated a recent analogy in an article from Becker’s Healthcare regarding this topic and the impingement on physician autonomy, that physicians had become, [instead of] “tiger cubs that were born to be at the top of the food chain,…simply the caged tigers in a circus.”   Time will tell whether the forces that have led to that will have been locked on the inside of these cages as well.


So, that moment, though fleeting, remains powerful and its effects, enduring.  This spirit continues with a sense of gratitude, humility, stewardship and awe.  Let nothing pilfer the authenticity of what we do.  In that instant, as I held her hand, I understood that she was holding mine. 

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