From the
President
Wayne Tuckson, MD
GLMS President | [email protected]
YES, WE ARE Still Relevant
T
hose of you who remember the
cortical homunculus will recall
the outsized representation for
the hand. This representation
reflected the amount of corti-
cal resources dedicated to maintaining the
functions of the hand, which I’m sure our
colleagues in hand surgery will say accu-
rately reflects the importance of the hands,
and them.
When I rotated through surgery as a
third-year student in the late 1970’s, the in-
structor, whose charge was to prepare us for
the operating room and its environment, pre-
sented us with a variation on the homunculus
that was unabashedly skewed towards a sur-
gical perspective. This homunculus depicted
an operating room in which the surgeon, like
Godzilla standing over Tokyo, towered over
the operating room, and all others within it.
The health care team has traditionally
included physicians, nurses, allied health
workers, physicians’ assistants, pharmacists,
social workers and hospital administrators.
It was by virtue of our training and study
that we, the physicians, were given authority
and responsibility over the development and
execution of health care policy and practices.
There was a dialogue between physicians and
other members of the health care team, but it
was more one sided with physicians speaking
to the various stakeholders. As Bob Dylan
sang, “Times, they are a’changin’.”
Now, we find ourselves in a position not
too dissimilar to that faced by Bill Clinton
in 1995 when he confronted a political land-
scape dominated by Newt Gingrich and “The
Contract With America.” Clinton faced a
threat to his executive power and the im-
portance of the presidency. To this threat,
Clinton declared, “I am relevant,” and though
things had changed, Clinton succeeded in
both re-establishing his importance and that
of the presidency.
The health care team of today is com-
posed of the traditional members, but is now
dominated by health care economists, big
data specialists, an alphabet soup of gov-
ernment agencies, health insurers, hospital
administrators and practice managers. In
addition to the new players, greater authority
has been extended to other members of the
team, further diminishing the role of the
physician. This is not necessarily a bad thing
as the unique perspective of these stakehold-
ers gives both a broader and more in-depth
understanding of the problems and potential
solutions that we all face. However, these
changes have altered the nature of the con-
versation and who controls the dialogue, if
one even exists.
patients, be it at the bedside, the office, the
operating room, the ER, or anywhere else
that we interact with people, we can and must
influence and inform their health behaviors
and attitudes and make them aware of their
roles in the health of the community. When
interacting with other members of the health
care team, it is our deportment that will,
either positively or negatively, impact their
behaviors and attitudes.
The health care landscape has changed,
and this has had an impact upon us. How-
ever, there is no going back. Now, more than
ever, we must stay engaged and not abdicate
either our fate, how we interact with our
patients, or the responsibility for the health
of our community to others. We remain the
best suited to respond to changing health care
needs, because after all, this is what we do.
Dr. Tuckson is a practicing colon and rectal
surgeon.
So, we are no longer the coach of the
team, but we are still the quarterback and
the face of the team. Wherever we encounter
SEPTEMBER 2018
5