As in years past, healthcare often led the news. Although science continues to advance at a rapid pace, the implementation of our new knowledge has yet to catch up in practice for many reasons. Despite the increase of political rhetoric addressing the problems in the healthcare system, little has been done to improve the delivery, bring down costs, or address widening disparities in medical care. Many moments in healthcare filled me with fear for what the future of medicine will become. Yet, others gave me great hope that positive change is coming.
The not so great moments:
- Data breaches
The year 2018 brought greater anxiety over cybersecurity regarding medical records. One of the largest healthcare breeches occurred in June and July in Minnesota DHS putting approximately 21,000 medical records at risk. In the same time period, a phishing attack put 37,000 records at risk in California. Many similar attacks were carried out drawing attention to the vulnerabilities in electronic health records. In total, it has been estimated that over thirteen million records were put at risk this year. As doctors were basically mandated to adapt EHRs as part of their practice, I think it is time to demand security for our patients’ health data in 2019.
- Unaffordabilty/ACA/Trump
While the Affordable Care Act (ACA) set out to make healthcare more affordable, most data shows that it failed in this regard. However, the solution is not a blind repeal without a good alternative in place as pontificated by the POTUS. His plan to repeal the law will have dire consequences for those insured under those plans. We need good alternatives, not political revenge. No one can argue that healthcare is unaffordable for many. It is the largest expense of the US economy. The question is not what to do with the ACA. What we must address is how we fix our dysfunctional healthcare system and help patients afford medical services while preventing the nation from going bankrupt due to healthcare costs.
- Consolidation and mergers
For me, this is perhaps the most frightening movement in the industry. When these large for-profit companies control healthcare, what is going to happen to patients? While Aetna and CVS try to finalize their mega-merger, at least one judge, US District Court Judge Richard Leon, placed a pause in the process. Many people have called for increased competition among health insurers. These mergers kill any competition and create more limitations in an already ailing system. And who doesn’t see this as an anti-trust issue?
The learning moments:
- Vaping chat:
In September and October, I co-hosted a two part twitter chat with Physician’s Weekly on the dangers of vaping. Although we invited many doctors and other healthcare experts to join us, it was largely attended by vaping advocates. We did attempt to discuss the available science such as the nicotine present in vaping fumes leading to inflammation in respiratory epithelium and possible harms of artificial flavorings used. The vapers were having none of it and came out swinging, citing the Royal College of England claiming that “vaping is 95% safer than smoking”. While I was called many names, I came to see that for people who were able to quit smoking by vaping, maybe this is a good alternative. However, I still insist that we don’t know all the dangers and more research is needed, despite what the Royal College says.
- Public losing trust in doctors
In this article that I wrote for Physician’s Weekly in 2015, I listed my thoughts as to why I think patients are losing trust in doctors. Three years later, the comments are still going strong and they are mostly negative comments about doctors, myself included. I didn’t realize when I wrote this how passionate patients feel on this issue and I now see the trust issue as a much bigger problem than just a lack of good communication. I don’t mind that people take aim at me in their anger, despite the fact that I was not the doctor who wronged them, but I do want to see some real solutions offered. Telling me I’m “egotistical and arrogant” doesn’t help fix the problem. Telling me I think “I’m better than others because of my elitist family background” is just wrong because you don’t know I grew up poor with an alcoholic, abusive father and left home when I was 18 years old, never receiving a penny of help except through student loans and what I earned. Truth is, my background is probably more “white trash” than anyone else. But OK, how do we fix those who may have arrived at their medical education through easier channels? I personally don’t think it matters so much. I think the question that should be addressed is what do patients want from doctors.
The amazing moments:
- This is our lane
In November, the NRA tweeted, in response to a position paper about gun violence in the Annals of Internal Medicine, “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves”. In response, doctors came out in full force on social media posting their own experiences treating gunshot victims, including bloody pictures, under the hashtag “ThisIsOurLane”. This quickly went viral and was covered in all major and minor media outlets. I was humbled to be part of this movement, including being interviewed in Time. Hopefully, we will see stricter gun laws and less school/mass shootings in 2019.
- PROWD
One of my proudest moments of 2018 was becoming one of the founding members of PROWD (Promoting and Respecting Our Women Doctors). During this year, the #BeEthical campaign was launched by Dr. Julie Silver, our leader. It is now the 21st Century, time for the genders to be treated equally in the workplace.
3. Physician’s Weekly
In the fall, I was asked to become Editor-in-Chief of Physican’s Weekly. While I’ve worked with many media outlets over the last few years, Physician’s Weekly will always hold a very special place in my heart as they are the ones who gave me the start in my writing career. No matter who I work with in media, no one will ever compare to Janine Anthes and Chris Cole, who I feel are my kindred spirits and truly “get” me. Their dedication to their work and helping doctors get their voices heard continually inspires me. Plus, no one makes me laugh like they do. Hope 2019 is the year we become recognized as THE media outlet of physicians.
4. Discovering personal healthcare heroes
Despite the fact that doctors face increasing disdain among the media and general public, the fact remains that many doctors stand up to their true calling. Though I mention this last, this is my most defining moment in 2018 as it was one of my most intimate experiences. During the month of June, I tore the medial meniscus in my right knee and was scheduled for surgery to repair it. The week before the surgery was scheduled, my knee gave out after my dog took off to protect me from a killer squirrel and I was dragged off the porch at the end of the leash landing at the exact point that fractured my proximal humerus into three separate fragments. I can say without pause that this was one of the most painful experiences of my life. Emergency surgery was done, and I now sport a new titanium plate screwed into my shoulder. The recovery has been a torturous and emotional process. Five months later, although mostly recovered, I still experience pain and some decreased mobility. In this journey, I discovered one of those many doctors who still understands what it truly means to be a doctor: Mahmud Ibrahim, MD. Without his kindness and skill, I would still be struggling to function at work. He will forever and always be one of my personal healthcare heroes. While people enjoy superhero movies, those we meet in real life are so much more impressive. I will never be able to find enough words to express my gratitude to this amazing doctor who gives me hope that doctors still believe in their purpose and that I will get back to full functioning.
In 2019, we have room for great improvements in medicine, not just in the evidence we possess, but in its delivery. However, if we stand silent while watching travesties happening to patients, nothing will change. Doctors need to speak up but that is not going to be enough. Our numbers are limited. Patients need to rise up as well. Soon, we will be in a new year. Will this be the year that you will speak up? Or will we be facing the same issues as 2020 approaches?
Copyright secured by Digiprove © 2018 Linda Girgis, MD, FAAFP
while the problems are diverse, indeed predictable from one year to the next, the primary barrier to fixing any of this may be the adversarial first response that any attempt at upgrading brings forth in short order. When Stehphen Covey published his mega-bestseller, “The 7 Habits”, now about 30 years old yet as valid as when it first got to the bookstores, he began his work with some basic sciece, much like we depend of basic science as the foundation of what we recommend. He divided people into about a dozen individual centers that people have, from money to religion, that guides how they choose among the options that they have. The people who invariably accomplished the least were the people who he called Enemy Centered. They are fixated on what their enemy might do, how they might avert an assault, and counterattack. They are always in a defensive mode instead of a remedial one. That’s our daily news, our social media, and to some extent our medical lives. Our enemies are the insurers, the ABIM, the administrators of our networks, our EHR, Medicare, The ACA or its repeal.
If there is one unifying theme to a very thoughtful, diverse annual summary, it may be the desire to tilt at those windmills that will not disappear, be they mass shootings, our patients’ critical perceptions, an EHR purchased by people who think revenue and not patient care, or endless other impediments to fulfilling what we thought should be our professional destinies. Amid this blight, there are elements that move beyond Covey’s Sphere of Concern to his Spheres of Influence. We can take attentive care of our people, we can give the pre-auth people what they need to approve what we want, we can write or representatives. Never be Enemy Centered.
Great comment! Thanks for sharing.
Dr. Linda