Stanley Feld M.D.,FACP,MACE

It is important to listen to what physicians are saying. An article appeared in SERMO, a physicians’ social network, which expressed a physician’s frustration.

It is appropriate to publish some of that physician’s thoughts.

“I first heard this statement over twenty years ago, when I was an intern in general surgery, struggling to find my professional self.”

“My chief resident said; “The patient owns the disease,” “You’re not trying to make them suffer, you’re trying to help. They’re sick, you’re not.”

“The human body is unpredictable.  Disease complications happen.”

The author thought his chief resident was heartless and callous. In a way, he was but he was getting at the heart of the matter. What is the patient’s responsibility in the evolution of disease?

This physician took everything that happened to his patients personally.

The patient owns his disease. The physician does not own the patient’s disease. Lifestyle plays a large role in the cost of the healthcare system.

President Obama’s healthcare reform law ignores the central role patients play in the therapeutic equation.

Day after day in the Emergency Department, people who take no responsibility for their health confront me.  They smoke, they drink, they do drugs, they don’t take their medicines, they drive impaired and crash, and yet they expect me to make them well.

They visit at their convenience, complain about the wait, want their medicines for free, and then don’t pay their bills.

The concepts of health insurance, family doctors, and preventive care have been completely lost.  Everybody except the patient owns the disease.

There was a time that patients knew they owned their disease. They knew they were partners with physicians in the treatment of their disease. Patients had to do the best they could under their physicians’ guidance.

“Somewhere, somehow, things got turned around.  The patients no longer own their diseases.  They’ve given them to us – physicians and society at large.

We are held responsible for everything that happens to a person, regardless of how they conduct their lives or follow our instructions.

  The weight on our shoulders is crushingly real, and forcing many good physicians to walk away from the thing they love most – taking care of others.”

He goes on to say;

I’m still shocked when a patient says, “You have to ….”  It’s endless – “refill my blood pressure and diabetes medicines, even though I don’t know their names or the dose. Patients demand I order an MRI for their two years of knee pain.”

“Say no, explain why, try to educate, offer alternatives, and the reply is  “If you don’t do it and something bad happens, it’s your fault.”

“You can’t tell someone that his or her symptoms are due to obesity, smoking or drinking – that’s judgmental.”

The author’s examples are endless. One last example sums up the dilemma facing healthcare in America.

“I once believed that every time I gave in to a patient’s pressure for an antibiotic for a viral illness, I was contributing to the emergence of super-resistant organisms.

“I believed that I could control the run-away cost of health care by judiciously ordering advanced studies only when absolutely necessary.  I tried to convince people that they owned the disease, that they had responsibilities to meet, that they couldn’t just demand everything be given to them.  And now I’m labeled a “disruptive physician”, because I generate too many complaints.

The increasing prevalence of obesity is a concrete example of the need for patients accepting responsibility for their disease.

Obesity is the cause of many disease processes. Obesity is not a random occurrence. It is linked to eating more than you burn. Potential patients are responsible for their obesity.

When obesity leads to the onset of Diabetes Mellitus, patients are responsible for controlling their blood sugar so they do not develop the complication of Diabetes Mellitus. The complications are heart attacks, hypertension, strokes, blindness, or kidney failure.

The government must provide and promote public education about obesity. Somehow, the appeal of overeating must be squashed and the virtues of exercise promoted.

Physicians and their healthcare teams are responsible for teaching patients how to control their blood sugar.

Eighty percent of the healthcare costs are the result of the complications of chronic diseases. Physicians must be encouraged, not forced, to set up systems of care to help patients become responsible for their chronic disease.

Where is the motivation for physicians in President Obama’s healthcare reform law? Where is the motivation for patients to become serious about intensively controlling their blood sugars in President Obama’s healthcare reform bill? New agencies are being set up to penalize physicians for not using resources to set up systems of care, resources which are uncompensated.

President Obama’s healthcare reform law does not promote patients taking responsibility for their diseases. The law contains nothing that measures patients’ performance. The law contains a lot of proposals that will falsely measure physicians’ performance

The law uses the term preventive care. It is meaningless without providing details. Prevention is immediately defined as providing vaccinations. Vaccinations do not define preventive chronic disease management.

If we are going to decrease the acute and chronic complications of chronic diseases, patients must comply with their physician’s recommendations.

Systems of care for chronic disease management have to be taught to patients and physicians. Medical schools have taught physicians how to treat diseases after its onset. President Obama should focus on setting up systems of public education before the onset of chronic disease.

President Obama’s healthcare reform act puts the burden of successful outcomes on physicians. Physicians do not own their patients diseases.

He should focusing on where money is wasted not building an infrastructure that will waste more money.

“Somewhere between the past paternalistic model of the physician-patient relationship and today’s give-them-what-they-want system, there has to exist a better paradigm.

As doctors, we need to resist the external pressures to make every one happy.  We must legitimize our expectations and have the backing of hospital administration when appropriate.

We should be empowered to refuse unnecessary, expensive, and often harmful demands. We cannot continue to abdicate the responsibility of our education and profession to political correctness.”

The Sermo physician’s statement demands physician leadership for constructive change. He says just say no.

It is difficult for most physicians to say no when they will be penalized by their hospital administrator or get sued under present malpractice laws.

Patients must own their disease!

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.