Let us ask this: what ultimately is the goal of our profession of medicine? The answer most of us would give is at the individual level, our effort to the best of our ability to improve the health of an individual. The oath sworn, allegedly sacred although that element now sadly is lacking, identifies that element above all else. There is nothing about balance of life and work, the emphasis on technology, even on mending societal ills (despite what I have written in Substack). These latter elements are extensions designed to link our practice to a wider responsibility, and now some medical schools, such as I learned about recently occurring in California, are providing courses on DEI, etc. Are there disparities in outcomes based "solely" on race? Perhaps, especially as we know rather firmly there are different attitudes towards health, etc. If one want to fix society, the answer lies not in knowing "medicine" but in understanding how to craft institutions, a function for which we are not trained. Go into politics or public service systems, etc., but with the shortage of physicians we have allowed the direction of our profession to change from providing individual care to "societal care". The skills required are very different.
To me it is a fundamental error to think correcting any of those issues outlined, or all of them, somehow will "fix" our system. This comment is NOT intended to say everything is fine. It isn't, but from my perspective the greatest deficiency in our profession is that the newest crop of "physicians" do not have the basic skills to provide competent care. I have witnessed the change in steps to ordering a bunch of tests before a competent history and even cursory exam is performed, in which medical errors are perpetrated because it is too easy to push a "cut and paste", and No One looks at old records. Institutions determine the length of visits and compensation based on ROI in salary, with incentives attached. While these perversions always have existed, they have expanded now to include all caregivers at all levels. As our so-called progress places more and more emphasis on institutions we will lack "caring" physicians and nurses whose primary responsibilities will be in conflict with the ethics of our profession, at least as it used to be.
Let us ask this: what ultimately is the goal of our profession of medicine? The answer most of us would give is at the individual level, our effort to the best of our ability to improve the health of an individual. The oath sworn, allegedly sacred although that element now sadly is lacking, identifies that element above all else. There is nothing about balance of life and work, the emphasis on technology, even on mending societal ills (despite what I have written in Substack). These latter elements are extensions designed to link our practice to a wider responsibility, and now some medical schools, such as I learned about recently occurring in California, are providing courses on DEI, etc. Are there disparities in outcomes based "solely" on race? Perhaps, especially as we know rather firmly there are different attitudes towards health, etc. If one want to fix society, the answer lies not in knowing "medicine" but in understanding how to craft institutions, a function for which we are not trained. Go into politics or public service systems, etc., but with the shortage of physicians we have allowed the direction of our profession to change from providing individual care to "societal care". The skills required are very different.
To me it is a fundamental error to think correcting any of those issues outlined, or all of them, somehow will "fix" our system. This comment is NOT intended to say everything is fine. It isn't, but from my perspective the greatest deficiency in our profession is that the newest crop of "physicians" do not have the basic skills to provide competent care. I have witnessed the change in steps to ordering a bunch of tests before a competent history and even cursory exam is performed, in which medical errors are perpetrated because it is too easy to push a "cut and paste", and No One looks at old records. Institutions determine the length of visits and compensation based on ROI in salary, with incentives attached. While these perversions always have existed, they have expanded now to include all caregivers at all levels. As our so-called progress places more and more emphasis on institutions we will lack "caring" physicians and nurses whose primary responsibilities will be in conflict with the ethics of our profession, at least as it used to be.