As I entered the exam room I knew something was up. It was the first time my patient was accompanied by his wife. I’ve seen this before when families come with their loved ones who are having tough times or receiving bad news. In poker it’s called a “tell” and occurs when your emotions betray the four aces you’ve just been dealt. Only this time it wasn’t four aces this stalwart professional had been dealt. It took only a moment for me to realize that things had drastically changed since I last saw him. This community leader with dementia now needed his wife’s help.
It’s no secret that I’ve been troubled by the state of my country, the medical profession and my company. It’s not working and anyone with intellectual honesty or integrity knows it. There comes a time when you realize you’ve done all you can and it wasn’t enough. I have made a difference in the lives of many, but you always wish you could have done more.
I like the poetry of Emily Dickinson. One of her poems resonates with me these days:
Success is counted sweetest
By those who ne’re succeed
To comprehend a nectar
Requires sorest need.
Not one of the purple Host
Who took the Flag today
Can tell the definition
So clear of Victory
As he defeated—dying—
On whose forbidden ear
The distant strains of triumph
Burst agonized and clear!
Luke was the author of Acts and the third New Testament Gospel. I believe he was an internist even though there weren’t “specialists” 2000 years ago. Luke certainly approached issues like an internist. In the opening lines of his Gospel he said he “carefully investigated everything from the beginning…so the [the reader] may know the certainty of things…taught.”
Of Luke’s many stories, one in particular resonates with me these days. Two of Jesus’ friends were the sisters named Martha and Mary. One day Jesus (and I suspect his entourage) came to supper at the sisters’ home. Martha was quickly caught up in the business of hospitality and eventually complained to Jesus that her sister Mary wasn’t helping her with preparations and dinner. With his loving touch The Master pointed out that Mary had chosen to sit with Jesus, and that her choice “is best and it will not be taken from her.”
It’s time for me to choose what is best.
For more than two thirds of my life I have been focused on medicine. First it was the sacrifices to succeed in college and get into medical school. Then there were the challenges of medical school and post-doctoral residency training. And for the last thirty-four years I’ve practiced my trade and cared for my patients. The world is changing and so must I.
My plan was to wait until the end of the year to announce that I was leaving Summit Medical Group and private practice. But ever increasing numbers of patients ask me if I’ll be able to continue another year. I cannot be dishonest. There are too many lies these days by our titular leaders whose dishonesty is perverse and pernicious. The Washington Post recently awarded Obama “four Pinocchio’s” for his statements regarding his signature legislation, Obamacare. Pinocchio’s be damned! A lie is a lie if you have the courage to speak the truth.
Our country is in crisis and I believe it is ruled by people who have betrayed America’s trust. The Chronicler in 2nd Chronicles 7:14 outlines the solution to our problems. We must choose the wisdom of the ages rather than follow the Belt Way boys to certain destruction.
These days I am asked to change my principles; I cannot and be true to myself or to those I serve. I have three options: change the system – I have concluded after years of effort I cannot; change my foundational principles and get along; or leave the system. A friend of mine suggested I “compartmentalize” my feelings, but after reflection I conclude this is just a variation of the 2nd option and unacceptable.
After a year of reflection and soul searching I must go away for a time. It would be nice if doctors could step back and take sabbaticals like those in academia. However, when you are responsible for people’s care you can’t wander off to some mountain top or a monastery for reflection. In my profession it is either 110% or not at all. I have decided that it must be not at all for awhile.
I am not alone in this difficult decision. Studies say that 70% of physicians are now thinking of quitting medical practice. Many of my colleagues are thinking of the end-game strategy. This week two physicians in their mid-fifties told me that they must hang in for five more years and then they’ll quit.
Who will care for the tsunami of baby-boomers now entering retirement age? I suspect a lot of care will be done by physician assistants and nurse practioners who are trained differently than physicians. Experts predict that routine care and mild illness will be handled by “healthcare providers” in Wal-Mart, Walgreens and CVS-like venues. If you’re really sick you’ll go to the emergency room and the system will then assign you a doctor.
It has been an honor and a privilege to serve the thousands of people who call me their doctor. I will still be available in the Focus and perhaps elsewhere someday. Who knows what will happen in 2014? It was Mark Twain who once quipped, “The news of my death has been greatly exaggerated.” The same applies to me.