Improving Education 293
Several changes were suggested for the system of medical practice.
Eleanor, for example, said:
Medicine is a business, or would like to be a business, but doesn’t
play by business rules. I wish more bright businesspeople would go
into hospital administration and cure these problems.
Administrative problems, like medical problems, require treatment. And
policymakers and administrators would benefit from heeding more the
problems with the bureaucracy and the physical plant that these ill
doctors voiced.
Simon, the radiologist with HIV who refused audiotaping, saw a need
to revamp disability insurance to allow doctors to return to work if they
feel better, yet not lose their disability insurance. (‘‘People should not
have to leave medicine.’’)
Current policies also contributed to HIV-infected health care workers
facing stigma and discrimination that impaired their lives, work, and
care. Arguments have been made that a physician should disclose his or
her HIV status to all patients, regardless of the procedures performed.
Yet such policies need to be carefully considered since they can hamper
the lives of these providers, causing stresses that can threaten the quality
of care these physicians deliver to their patients. Policies should ensure
the least possible bias against these doctors, and establish adequate safe-
guards to prevent discrimination. If these physicians can be offered as
much support and the least discrimination as possible, they can be of
even more assistance to their patients.
Strongly entrenched norms in the profession—that physicians have
to ‘‘be strong,’’ not ‘‘weak’’ or emotional—contribute to burnout, and
hence should be reassessed and altered. Medical training would benefit
from explicitly and proactively trying to ameliorate these problems, so
that trainees can best prepare for, and remedy, these difficulties. For ill
doctors, interventions can be designed using physician-only support
groups; helping doctors’ family members in aiding ill physicians; pro-
viding guidance and consultation on how to establish and maintain ap-
propriate boundaries; identifying and treating mental health symptoms
proactively (e.g., overcoming stigma surrounding physician mental ill-
ness); and assisting with consideration of, and transition to, other jobs.
Local and national medical groups and societies (e.g., the AMA and
local medical associations) should be aware of these intricacies, and
can play vital roles, but need to tailor programs appropriately. Burnout