Only a few months ago, I was a practicing physician, specializing in anesthesiology. Thirteen years prior, when I initially graduated from residency and entered the big, bright world of private practice, the world of medicine was a vastly different playground. Computers played a minor role in patient care. For example, physician’s notes were handwritten/scribbled in patient’s charts in frequently undecipherable scrawl. Autonomy was nearly absolute, as doctors had very few people looking over their shoulders and questioning their judgments. There weren’t many governing or unifying rules, except some loosely defined common notion of ‘standard of care.’ Doctor’s behavior was often abhorrent – some acted like arrogant, sexist cowboys, while others behaved like self-entitled Gods.
The picture I paint of medicine barely more than a decade ago sounds ugly – like the lawlessness of the Wild West. Actually, back then, medicine was fun. Doctors were able to make judgment calls based upon their education and experience. Just because one doctor did something one way, and another physician chose a different approach, as long as a safe outcome was achieved, it didn’t matter. I remember being trained with the motto, “There’s more than one way to skin an anesthesia cat.” Therein lies the beauty of that era and part of the attraction that so many felt toward a career in medicine.
During my thirteen years as a practicing physician, a vile plague began to seep its way into our careers. First, JCAHO came into existence. A governmental entity manned by people who worked behind desks to come in and tell those of us in the trenches how to best proved patient care. In reality, JCAHO was a joke. The hospitals had fair warning when the regulation Nazis would be showing up. In fact, they’d announce “Code Gold” overhead, indicating the assault of minions with no clinical experience was imminent. For that day, we didn’t eat or drink in the OR, we wore eye shields, and time outs were done with the utmost diligence prior to the beginning of a procedure. Hallways that were chronically clogged with racks of hospital equipment were temporarily cleared out. The next day, when the coast was clear, we would all saunter back into the OR with our Styrofoam cups of coffee in one hand, donut in the other, and Sudoku puzzles tucked under our arms. The presence of which had no impact on patient care.
As the years passed, the insidious regulations became more stifling. For example, preoperative antibiotics had to be administered to the patient within 60 minutes prior to incision. Note that this does not mean that the drugs were actually injected into the patient within the dictated time frame, but the documentation made it look as though it were the case. The bottom line is that many of these rules weren’t taken seriously – perhaps in part resulting from sheer protest by physicians being stripped of their autonomy.
In the months prior to my departing the world of syringes and endotracheal tubes, a rule came down the pipeline that anesthesiologists would no longer be able to carry their personal bags into the OR. For gas passers, our portable suitcases are often a lifeline. We cram them with special equipment, useful textbooks, and medical journals that can all be retrieved in a heartbeat if needed. The reasoning for the ban on our bags? Germs. Although my stethoscope came from the outside, as did my shoes, my jewelry, and my pen – all of which were much more likely to come into direct contact with a patient – these were not the targets. Our bags that sat against the wall of the OR, at least 10 feet from they patient, were the source of evil, infection, morbidity, and mortality. There was no study to substantiate that claim. Just another idiot bureaucrat with a wiry hair very far up their backend. Not to mention they forced us to leave our bags carrying our personal computers, cell phones, money, and other valuable belongings in an empty and unlocked office.
Which brings me to the million-dollar question. What will happen to the world of medicine as more bureaucracy infiltrates every aspect of patient care? If a patient has suspected appendicitis, will the attending physician only be able to write orders from a preprinted form? Will there be any tolerance or allowance for personal variations? Will doctors ever have to use their minds again?
This obliteration of physician autonomy causes the allure of medicine to evaporate like steam from a teakettle. I envision the day when doctors will be reduced to robotic drones, not to mention being overworked and grossly underpaid. So what will happen? Will there be a mass exodus, as many have recently predicted? Perhaps. But the hard reality is that there are very few options for physicians looking to get out of medicine. Some may successfully transition into law, hospital administration, or pharmaceutical and medical device positions. However, such transitions are not easy, not quick, not cheap, and not in huge supply. The sad truth is that many physicians will quickly realize that they are imprisoned by a career that they dislike – chained to a profession by mountains of student debt and non-transferrable skills. And these are the individuals that will be taking care of our children, our parents, and ourselves.
I pray for good health.