OPINION Response
by JOSEPH FLYNN , DO , MPH , FACP AND AARON SPALDING , MD , PHD
In response to the article titled Revolting Sheep by Dr . Larry Griffin in the A Second Opinion section , we hope to address broad strokes of assumptions and a significant absence of objective evidence . Importantly , neither the author ’ s likening of physicians to sheep nor cats truly reflects admirable characteristics of a historically honorable profession . To make unfounded claims that one event in the complicated history of health care was responsible for indelibly altering the qualities of physicians broadly is patently absurd . While no system is without flaws , it can be safely stated that there are many benefits of the physician and hospital system relationship that impact the quality of patient care .
One only has to look at recent history to see the profound positive impact on patients , physicians and , more widely , caregivers . COVID-19 was a once in a hundred years assault on mankind . Many evidence-based articles clearly demonstrate that the strength of our medical response was significantly augmented by health systems . Organizing resources to ensure adequate personal protective equipment , aligning personnel and locations to best care for patients , and supporting the needs of physicians ,
nurses and other members of the health care team to battle that onslaught would have been nearly impossible without an organized approach that larger systems offer .
Many of the costs alluded to in Dr . Griffin ’ s opinion piece are not the result of health systems but are due to the continuing pressure on advancing technology , pharmacology and patient demands . The backstop of heath care systems has allowed physicians to better care for patients and have more freedom to provide advanced care that would have been prohibitive otherwise . As these systems have continued , physicians are better able to subspecialize and focus in areas that would have been the sole bastion of university-based academic institutions .
Further , these systems offer the tools to utilize directly available population-based data in order to address health concerns and enhance quality . These systems allow clinical research to flourish in ways never seen before . For instance , in oncology , now over 70 % of drug discovery occurs where most of our patients are — in the community or health system . Physicians in these systems are able to remain active in the realm of clinical research and maintain an interest that would otherwise have been extinguished . As a result of efficient research support in the health systems of today , regulatory issues , research coordinators , specialty pharmacy and medical writers can be supported centrally , allowing physicians to focus on the joy of discovery .
In order to understand health systems , one has to have an understanding of the changes in reimbursement , which Dr . Griffin seems to avoid . Were it not for the development of health systems , we still would be documenting in disconnected paper charts and our actionable information would be prevented from benefiting patients on a wholesale level . What once was an entrepreneurial opportunity for physicians to “ hang a shingle ” has become a complicated business structure filled with negotiating contracts with managed care , managing supply chain challenges , investing in electronic medical records and , ultimately , working through the complicated compliance structure of the U . S . health care system .
Caring for patients is a privilege , and we are arriving in a new era of medicine where we truly can advance , not just to treat , but to cure disease . The past years have seen significant advances in biologics and technology to improve the care of patients . We believe the future of our wonderful profession thrives in partnership with health care systems and a team-based structure . This structure includes social workers , psychologists , physical therapists , nurses , nurse practitioners and clinical navigators . Our profession is no longer a physician-focused model , but a teambased structure that allows us to advance the best care delivery .
Interestingly , Dr . Griffin chose to reference sheep . Catgut , the tough cord made from the intestines of certain animals , particularly sheep , has been used for centuries as surgical sutures . Physicians will continue to care for patients in the centuries ahead , suturing the health care system together as scientists , clinicians and caregivers . The beauty of modern medicine is we have multiple models from which physicians may choose to develop their passion and desire to improve the lives of patients .
Dr . Flynn practices radiation oncology with Norton Healthcare . Dr . Spalding practices medical oncology with Norton Healthcare .
28 LOUISVILLE MEDICINE OPINION