• Rosalind Kaplan, MD

No Magic Pill for Change

It's suddenly really cold here! It feels like winter, and it seems like flu season is starting. Ugh- how did that happen? Not only that, but I can't stand to turn on the TV because there's a negative political ad on every other minute. Oh well- avoiding the toxicity and also getting my flu shot were all part of the plan to take care of myself. I'm trying. Some days are better than others. Trying to stay away from unnecessary drama and bad energy. How about you?

The problem is, we can't do it all ourselves. Is anything getting better out there in the world of medical practice? How are things going from the institutional standpoint? How about the systemic standpoint? I'm a little removed in my world of writing and editing and my part-time job doing Urgent Care, but I'm not living under a rock. I'm talking to people. I'm not hearing about a lot of change.

I did read some things that felt a little bit promising. One was that the American Board of Family Medicine is piloting a Maintenance of Certification program that sounds a lot more sane than anything that's been offered so far. As someone who is going to have to recertify yet again (the third time) in 2021, I am praying for a sane program by then. I will be almost 61. I can't imagine going through the whole crazy recertification process again, and I don't know if I'll be willing to, unless someone makes it educational for me and makes it work within my life. I'm not going to stop my life to do the MKSAP and take a crazy test full of material I won't be using.

The other thing that feels hopeful is that the people outside of medicine are finally starting to understand about the crisis in medicine. The article in the New York Times about medical burnout and depression and why doctors are so unhappy wasn't news, and it wasn't the most stunning article I've read on the topic, but it got the space in the New York Times Magazine. My friends outside of medicine aren't surprised when they hear about physician suicides and docs who have decided to hang up their stethoscopes to save their sanity. So maybe there's a crawl in the right direction.

Still, the way I see it, Medicine is going to have to be taken back over by doctors and patients. I don't mean that we are going to go back to owning our practices and having patients paying us out of pocket or paying us with chickens. But I do mean that we are going to have to make our voices heard. Patients need to know that their doctors can no longer keep this charade up. And that they, the patients, are going to lose what they really want- the attention and care of their doctors- if they don't take a stand. And doctors, particularly the front-line doctors- internists, ER docs, family practice doctors, all the specialties that give the most and get the least- have to stand up to the system that is offering us unacceptable, abusive work situations.

How do we stand up? That's always the question, isn't it?

First of all, we have to VOTE. We need to vote for people who are going to support fairness in healthcare for our patients, and a better quality of life for us. Secondly, we need to organize. Each of us alone has very little power but we have organizations and we should all think about putting a little time and/or money and/or energy into those organizations that lobby and advocate for us. We know the insurance company execs and hospital system administrators are the ones who are making money and also having better quality of life than we are, and that we're the ones who are taking all the responsibility for the patient's well-being. And yet, we just keep being good boys and girls and going to work and caring for our patients and doing our charts and getting our report cards. Aren't you ANGRY???? Put some of that anger to work.

It is awful that we're getting depressed and killing ourselves. I wish we were getting angry and putting pressure on the system to change. What if every doctor in a health system refused to sign his or her contract? What if we ALL didn't report our metrics? What if we all burned our report cards? What if we refused to do some of the ridiculous busywork that's foisted on us? The problem is we have to organize. We have to all stand together, or those who rebel will be fired and replaced because we're all seen as replaceable by the administrators, even if our patients don't agree. Time to unionize? Time to radicalize? Definitely time to stop taking the bullshit.

Okay, I'm getting ahead of myself. Start with voting and joining the ACP or an equivalent organization. Think about doing some lobbying. Maybe think about whether Medicare for All might be better than what we've got.

Then let's go from there.

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