Guilty as Charged

One of the basic premises at is that a successful remake of the health care system will occur when Medicine is restored to a profession and a new culture is created.   Physicians can and should occupy nearly every key leadership role in the new system.  The full responsibility for care outcomes rests with the physician.  No other person or discipline in the system has the training to interpret and apply results from the bio-medical literature  so that care can be evidence based.

More than anything a leader needs the respect of those around them.  If a leader is going to ask others to make personal issues secondary to a greater good then the same should be expected of the leader.  Leadership by example.  To be perceived as credible and virtuous  leaders of the transformation of the health care system  physicians must realize that the first changes to be made are all within.  Most surveys still reveal a high degree of public support, confidence and trust in physicians.  In fact more so for physicians than politicians and health care administrators.  However the personal and professional  imperfections present can not be ignored or swept under the rug.  With respect to personal issues there are those who still see doctors as arrogant,  rude, condescending, greedy, egotistical, uncaring and the list goes on.  At the professional level there are still some physicians practicing well below an acceptable competency level.  Also, it would be naive to deny that there are some physicians who have abused the system for personal financial gain to the detriment of their patients and the system.  Bad people or response to a bad system?  Doesn’t matter.  The profession as a whole needs to plead guilty as charged and address all of these issues.

Is there something to be learned from those in the profession with personal or professional blemishes?  Nature or nurture?  Bad apples to begin with or simply a weaker breed breaking under the pressure of an ever-increasing adversarial environment?  If the culture of the health care system truly was focused on quality and not just output would a physician then spend more time with patients?  Would these interactions be more personal?  Would the physician spend more time reading and engaging in other activities to maintain competency?  Would any of this improve outcomes and/or the system as a whole?  Again it only matters in that it provides a potential remedy.  But no excuses for bad behavior-ever.  Excuses and lack of action will hurt the cause.  The profession will need to continuously look for problems within, acknowledge them and fix them.  Look inward first.


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