Dr. Janson is an emergency physician at Lawrence General Hospital in Lawrence, MA. He is the author of a novel, Mal Practice, and a children's book, The Child in Our Heart, both available onhttp://pauljanson.com.
I have been practicing medicine now for 40 years, and the landscape has changed since I first put MD after my name. I remember hearing people say the expense of medical care was worth it if it helped just one person. It was a heady time back then, and we all agreed with that statement even if we did not really believe it.
We knew there was a limit to what could be spent to save a life, but we were devoted to saving it and to easing pain and suffering. Disease was the enemy, not the cost of treating it. We were in the Promised Land, and the promise was health.
What happened and why it happened, I cannot say, but we are in a different place today than when my journey began. I had been a physician for three years when the first CT scanner became available. It has been a long journey, in years and in technology, but that is only part of the change. Somewhere along the way the promise left us.
We find ourselves in a different world now, a world of finance and codes and guidelines. We encounter an ever-increasing scrutiny of our care directed at determining who will get the larger piece of an ever-shrinking reimbursement pie. We are captives in a land of business and market economics, and we are forced to worship the dollar to survive, just as Judah was led into captivity in Babylon and forced to worship a new god. But just as was true in Babylon, the writing is on the wall of this palace.
I make no pretense to being Daniel, but I can read what is written here: If you practice business instead of medicine, when you are done practicing you will have business, not health. You cannot worship gold and silver and expect to have anything else when you are done worshipping.
Emergency medicine is in the forefront of this controversy today whether we like it or not. Nowhere is the impact of guidelines or the consequences of the emphasis on coding and reimbursement more strongly felt. We are the entry point for many of the sick in this country, and we have an ethical and legal obligation to provide care for all who request it. Outpatient and inpatient care is often initiated in the ED, so the guidelines and coding begin there as well. What is equally certain is that the situation we face today will change. It will be different tomorrow, and what it becomes is something we can control. To ignore this fact is to allow medicine to continue without any correction. We must not begin to think of our role as just a job. We cannot expect anything to improve if we remain silent witnesses while medicine becomes business.
The care of our patients must always be foremost in our efforts, but we, as providers of that care, cannot ignore the financial burden that the health care system places on practitioners and patients alike. It is ultimately our patients who will pay —with their money, their taxes, their time, and their health — if the system becomes unworkable and unable to provide care. Our patients come to us for advice when they are ill because we possess the expertise to help them. And we, the practitioners of the noble art of medicine, should be offering advice on the ailing health care system. We have an obligation to offer our help, and it is we, the people who are most closely involved in providing the care, who understand the problem best.
Remaining silent is a breach of that responsibility and of the oath we took when we became practitioners. We need to support the organizations that will speak for us to ensure that solutions are consistent with quality of care. We need to participate in these organizations so they have our advice. We need to communicate our concerns to our elected officials and refuse to have our advice ignored.
Medicine has never been just a job. That statement has never been truer than it is today, despite the guidelines and coding and business attitude of medicine. We owe it to ourselves, to our patients, and to the future to speak up and be in the forefront of shaping medical care. We are the last resort for the sickest of our fellow humans, and we see the writing on the wall. We see the consequences of worshipping of money.
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