Saturday, October 17, 2015

Fighting the Tide

Working in healthcare today feels like being caught in a riptide at the beach- all the patients are up on the sand, struggling with their health and illness, but if they want to see their doctor, they have to wade out into the unfamiliar territory of the surf.

Yes, there is some necessity of having sterile and unnatural exam rooms that are centralized for efficiency and throughput.

But l feel like we doctors are getting sucked out to sea. As care provider organizations like hospital and primary care practices consolidate, we are pulled back from the shore. We are pulled out of communities, away from neighborhoods, and are comfortably situated within the colossus of gleaming buildings and parking garages.

I admitted an 84 year old woman to the hospital recently with hip pain that had been ongoing for over a year. She had just been admitted two weeks ago with constipation and hip pain and asked to see her primary care doctor. I asked her why she wasn't able to see her doctor, and she told me it was too hard--too much time on the phone, traffic, parking, schedule availability. Instead, she got a mammogram.

Like so many, this woman feels stranded on the dry sand.

I want to get out of the water and up there on the sand too. I aspire to provide the basics of care-- hip pain and hypertension-- but also grapple with issues that threaten health that are completely unreachable from the water. I want to help with racism, gun violence, poverty, housing, education, and everything else.

The "system" is not going to change course and put us up on the sand. We doctors have to figure out how to get up there.

Oddly, it's there every time I step outside. I walk through the sand, past the housing developments and impoverished minority groups, through the structural racism and violence, and out into the waters of the medical industrial complex. I comfortably turn a blind eye, ease into the surf, and wait for problems to come to me.