Editor’s note: The following comments were received regarding recent articles published in the Bulletin.
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It’s not the good old days
As surgeons, the coronavirus (COVID-19) pandemic crisis has proven how vulnerable we and our patients are to the fiats of government “mandates.” The mandate that all elective surgery was to be canceled rang out in many states with little or no input from organized surgery with regard to what would be the best plan, and what would be in the best interests of patients. Each state mandated its own plan without any thought toward an organized national policy; many states did not seek or follow input from America’s surgical organizations.
How will the new administration deal with health care? We must wait and follow carefully. All citizens deserve basic health care. Emergency departments are required to take care of patients who seek care. Unfortunately, in some cases, those patients arrive with advanced disease. Many of us have worked in institutions where every patient was a unique individual, regardless of the patient’s diverse background or ability to pay. Local, state, and federal funds underwrote this process. A “sick tax” was built into the system—those who could pay, paid a little more, usually through their insurance programs.
Today, health care has become a business with stakeholders; things are rapidly changing for those who cannot afford health care, and in 2021 that often includes all but the wealthiest of patients. One frustrated response—not just from our poorest patients, but also from working families whose health insurance contributions can cost thousands of dollars a month—is to demand socialized, subsidized, government-directed health care. We warn them to beware. The handling of the pandemic is a clear example of how politicians manage—or don’t manage—health care when they are in charge. As physicians, we had better wake up and come up with a solution quickly.
Corporate medicine makes all of the aforementioned factors worse. The need to make a profit will seriously imperil caring for the poor. The employee-employer relationship will make the physician respond to the financial needs of the employer, and the employee will be graded by the employer on how well the employee has adhered to financial needs. Length of stay is already dictated by the insurance system. Medicine is increasingly being practiced using protocols established by committees, rather than by physicians meeting the needs of the individual patient. A break in protocol by ordering tests not in the protocol, or not discharging the patient from the hospital in the time dictated by the protocol, is punished financially. This process is gradually creeping into our system of care.
First and foremost, we must remember patients don’t care how much you know until they know how much you care. We must start to promote “caring” again across our profession. This requires reinserting professionalism into the profession.
So how do we begin to turn this ship around? First and foremost, we must remember patients don’t care how much you know until they know how much you care. We must start to promote “caring” again across our profession. This requires reinserting professionalism into the profession.
The onset of the 80-hour training workweek, put into place without any thoughtful input from the “House of Surgery,” began the trend of medicine becoming a “job” rather than a sacred profession—sacred because vulnerable humans place their lives in our hands each day. Our selection process for future physicians must become more mindful of the character traits of candidates. Illness does not have a time clock based on 80 hours. Experience cannot be gained effectively by individuals who value leisure time above seeing, spending time with, and listening to patients. These traits must be promoted vigorously before we can begin to design the best health care system for the U.S.
Members of the American College of Surgeons Academy of Master Surgeon Educators have masterfully navigated the COVID crisis to maintain appropriate surgical training within the framework of safety for patients, residents, students, and faculty members. Once the crisis is over, perhaps Academy Members could switch their attention to the concepts of education outlined in this letter.
Edward M. Copeland, MD, FACS
Gerald B. Healy, MD, FACS