As I await the dawn of my professional career, just weeks away from medical school graduation, I pause to reflect upon the long and arduous process that has led up to this point in time. Was it worth the long days and nights in the classroom, laboratories, and medical center? Was it worth the agony of time spent away from family and the loss of any semblance of a personal life?

Ideally, one would be able to answer “Of course” without hesitation. Sadly, however, I had to think about how to answer those questions for quite some time. Many of my fellow classmates have chosen to answer with a resounding “No!”, but I, after having pondered many moments, have decided that I may answer with a qualified “Yes.”

Why qualified? Because even though I still believe that being a physician is the noblest of all professions and that this is the career I should have chosen, Medicine is now at a crossroads, and getting the medical degree is simply not enough. There is much work to be done in order to keep Medicine in the spirit of Hippocrates and out of the demise of faceless bureaucracy.

Medicine has been described as being both an art and a science. Lest we forget, however, medicine began as an art. The “science” came much later. In that regard, the early focus of medicine has always been to reduce human suffering and to assist our fellow human beings in any way that was possible. “To Make Man Whole” is the motto of Loma Linda University, my medical school. It serves to remind us that human beings have more than just physical ailments, but also that they have a mental as well as spiritual component that may and should be included within the focus of our healing. I dare say that no matter where one has trained in medicine, this underlying philosophy is the driving force behind the academic and clinical curricula. It must be!

How shocking and stark, therefore, is the contrast when one reads any health insurance contract or HMO rules of membership. Our patients are cheapened to “clients” and “health-care recipients” while physicians are diluted to “contractors,” “providers,” (whatever that means), or “health associates.” The patient-doctor relationship, once the sacred cornerstone of good medicine, is slowly vaporizing into the realm of “managed competition,” which is itself an oxymoron. Patients must go to pre-approved “clinics” where a different physician sees them each time. Should they need urgent attention, medical records are often unavailable in the middle of the night, and all anyone really cares about is whether or not the patient is under a health plan, and, if so, “...is this visit authorized?” Nobody bothers to ask if this patient is about to crump or is too sick to go home until they can get “approval.”

And, if you think ClintonCare, the proposal that would have put the federal government in control of one-seventh of our nation’s economy, died in 1994, think again. Bill and Hillary are simply introducing their health plan in little bits and pieces. Last September, Clinton signed into law a bill requiring insurers to permit mothers to stay a minimum of two days after normal births and four days after C-section. This is another example of medicine by political demographics instead of by patient-physician decision the way it should be. Bill and Hillary want to pay New York teaching hospitals for not training residents. The implication is that skyrocketing medical costs are not due to excessive paperwork, bureaucrats, and mismanagement but to the eeeeevil and greeeedy physicians out there who would have the audacity to actually expect compensation for their skill and services.

So many physicians shake their head in wonderment thinking, “How did this ever happen?” What is more frightening is the fact that much of the next generation of physicians, my graduating class and beyond, is infected with the notion that all of this is inevitable. That government takeover and the loss of physician autonomy by “managed care” cannot be stopped and that we may as well learn to live with it.

Friends, we have but ourselves to blame. The onus is upon us to unite against the growing number of injustices forced against medicine today, and it is precisely that “roll over and play dead” mentality that will cause us to lose this most important debate.

The future of medicine is now, and we cannot afford to sit back and hope someone “does something about it.” We cannot afford to “hope” that bureaucrats will put our patients’ well-being ahead of their power-seeking agenda. We cannot afford to “hope” that we will be allowed to practice medicine based upon our skill and training instead of some cookbook algorithm concocted by pencil-pushing GEDs thousands of miles away. The stakes are far too high.

Even though most of us went to medical school to learn how to ease suffering, take care of patients, and nothing more, it is incumbent upon us all to realize that we will not be able to do these things properly if we continue to allow non-physician groups to progressively chip away at our freedom and autonomy. It is no longer enough to get your degree and practice blissfully ignorant of the business and politics that have come to engulf our profession, leaving such things to “those who care.” We must all care. We have to become politically active at the local, state, and federal level. In order to remain the patient advocates that we are, we must learn the code words of managed care in order to effectively combat areas where patient care is jeopardized. We must communicate within our community and, especially, amongst ourselves, how we feel medical care and patient needs should be met.

I eagerly look forward to graduation and to becoming the best physician that I can be. However, I also know that the new millennia of medicine brings with it new responsibilities and new challenges. I am confident that, united, we can recover the power and passion of our noblest profession.

 David K. Tan is President of the Class of 1997 at Loma Linda University School of Medicine in Southern California. He is also a member of the San Bernardino County Medical Society’s Committee on Legislation, and a student member of the AAPS.

Originally published in the Medical Sentinel 1997;2(3):110-111. Copyright ©1997Association of American Physicians and Surgeons (AAPS).