Practicing and Life Member CategorY Winner
2014 Richard Spear, MD, Memorial Essay Contest
changing environment can be as much a misnomer as progress. The
transition from independent practitioner and small business owner
offers new opportunities to witness government bureaucracy and
waste on a microcosmic scale.
Gambler. An actuary applies statistical modeling to determine
risk. My decision to enter medical school was made with far less
analysis than when setting the terms of an insurance policy. Success has been the result of providence, not planning. Today’s new
physicians cannot rely on dumb luck as I did. Escalating tuition,
the unsustainability of healthcare expenditures, and the downward
trajectory of physician compensation make any benefit/risk analysis
of whether to become a physician conjecture at best. We have no
idea where health care will be in five years, much less twenty, and
so embarking on a path to a medical degree is a financial crapshoot.
Heir. Since beginning my clinical career, I learned many truths,
tricks and efficiencies to improve my practice, but I have never
made a medical discovery. If you are like me, you relied on the instruction and innovation of our medical forefathers. Lister, Halsted
and DeBakey are distant names on my ancestral tree. The names
of medical relatives like Polk and Ernst are nearer to my own, and
their faces are familiar to me, and mine to them. The practice of
medicine is a fluid product of the vast legacy of curious thinkers
and daring innovators who may never have witnessed the profound
impact and geometric spread of their contributions.
Lobbyist. The surgeon general is the most high profile health
policy intercessor. But local physicians argue in the names of just
causes like air quality, fitness, colon cancer screening and heart
disease in women. A few petition in a judicial rather than legislative
sense, as when a forensic pathologist seeks justice for a victim who
has been forever silenced. We long to make lasting differences on
our patient’s lives. Sometimes it is the system that needs a doctor.
Patient. After deponent, “patient” is the second least favorable
name I am called. But as terrible tasting medicine can lead to a cure,
switching roles is an unpleasant route to empathy. We are subject
to the same afflictions facing our patients. As the passage of time
accelerates, our humanity and mortality confront us squarely in the
form of a hospital gown.
Provider. This is a new nickname for us, applied with increasing
frequency. It represents the most commonly used alias for physician since the turn of the millennium. For me it is dual in its connotation. It leaves me with a chilly, impersonal feeling when used
by members of my own health care organization, when I expected
something warmer. And it is demeaning when used by insurance
carriers, employers, and licensing organizations, when I expected
something more respectful. Unwelcome nicknames sometimes stick.
Public enemy. Whether ambushed by a doctor joke, or harpooned
blatantly by a critic, many physicians have felt accusatory fingers
drawing a bead on our profession, and maybe on us personally. As
suspected perpetrators of public maleficence, we are alleged to be
money-hungry vultures, earning our living from others’ suffering.
We hear we shirk responsibility for errors by “burying our mistakes.” Influences beyond our control force patient interactions to
be efficient and focused, and we appear aloof, uncaring and rushed.
Angry patients transitioning from one physician to another often
bash the former. As I listen I wonder if someday the same patient
will someday impugn my care to another physician. The barbs sting
the most when the accusations are true.
Savior. Fortunately this name is applied rarely, as overuse causes
encephalomegaly. Depending on our specialty, we might wrestle
patients from the jaws of death frequently. But most of us live quiet
lives of daily routine, only occasionally making r YX