No easy answers: Practicing medicine amid the push and pull of healthcare

I'm not sure if I love it or hate it when this happens, but today's issue of FiercePracticeManagement is an example of one that includes more discussion points than clear-cut advice. Many questions raised by these stories surround the idea of influence--identifying it, disclosing it and attempting to control it.

For example:

  • How does a doctor's personal life affect the way he or she practices medicine? How does that transparency shape a patient's choice of and interactions with that doctor?

  • How profoundly does involvement in a malpractice case impact a doctor's future decision-making? Is it ever possible for this experience to make one a better doctor? Is second-guessing one's judgment ever a positive? And if it's a negative, as Ruth Kannai, M.D., expressed in the Annals of Family Medicine, how can physicians learn to push those doubts and fears aside?

  • Is it fair to deny a physician's objectivity if they receive any form of industry payment, yet expect them to also make the best possible decisions for patients amid pressure to contain costs, drive revenue and achieve high patient satisfaction scores? Is the idea of following one's instincts distinct, or even still considered ethical?

  • Is bad morale contagious, not just within one practice, but throughout practices across the country? Even though the challenges facing physicians are very real, to what extent does reading repeated surveys rife with pessimism send doctors the message that they should be miserable?

These questions aren't rhetorical. I suspect that physicians' answers to them would vary considerably depending on their particular circumstances. The big question one might ask is whether it's possible, or even desirable, for doctors to simply ignore all the carrots and the sticks (both the intentional and accidental influencers) and just care for patients in the way they think is best?

But only a robot could exercise that kind of neutrality, one could argue. How could a doctor truly practice medicine without his or her humanity? The truth is we're all susceptible to all kinds of influences, only some of which we're consciously aware.

However, our society holds doctors to a higher standard. When I think about the doctors that treat my family members and me, my hope is that the voice that will speak to them the loudest is the one that comes from within. I understand it's not that simple. Practicing medicine is complicated, but it's healthcare that seems darned-near impossible.

As a publication, we strive to give you the best answers available. But this time, my advice is to use this (or any other) forum to talk. I know I'm eager to hear your thoughts on these matters, and am quite sure your peers, struggling with many of the same dilemmas, are all ears as well. - Deb (@PracticeMgt)