Death of the Medicine Men

I don’t hate my job. Not really. But I hate what it’s become. Because back in the day, only a few years ago, I got to practice real medicine.

I’d better explain that.

I didn’t don a white coat and a stethoscope, diagnose diseases, and prescribe pills. Instead, I “practiced” medicine by understanding, educating, empowering, and motivating my patients. And I did that by spending the time it took get to know them as people, because that’s what you need to do to treat diabetes successfully. And I “practiced” medicine by taking the time to learn about my patient’s lives, too, because life gets in the way of diabetes. If your child just died, you don’t really care if you are checking your blood sugar or not. If the power company just turned off your electricity, you probably can’t afford your meds. If your boss sexually harasses you at work, you might not want to lose weight for fear of being even more desirable.

And I “practiced” medicine by getting to know my patients’ diabetes itself; because no two cases of diabetes, even type 2 diabetes, are created equal. Some type 2s have high blood sugar all the time, some type 2s have sugars that rise in the night, some type 2s have sugars that only shoot up after meals. Same disease. Different incarnations. And that means different solutions are required. A blind prescription pad is impotent. Diabetes treatment isn’t one-size-fits-all. Understanding the patients, their lives, their diabetes; and helping them cope with and conquer their diabetes made me a healer, I think.

It was glorious work. I was a detective, a social anthropologist, a counselor, a cheerleader, and a little league coach all rolled into one. I woke every morning excited about taking on a new day’s challenges. I slept well at night knowing I had spent my day actually helping people.

But now I don’t sleep so well at night. I dread the alarm clock, and I have to drag my ass out of bed every morning, because times have changed. I’m not “practicing” real medicine anymore; I’m not sure any of us are. Every few weeks our assorted masters at the federal, state, and local levels mandate new things we must do. We are told: You must create care plans on X% of your hypertensive patients or kiss your funding good bye. You must measure waist circumference or there’ll be hell to pay. You must print a visit summary before the patient leaves. You must… You must… You must… You must…

The “you musts” are endless.

Now I spend nearly all my time with my nose in my computer, charting all the required minutiae in all the right places. It’s no longer sufficient that I check a patient’s blood pressure. I must also enter it in just the right place. And I must check the box that validates that I have just checked the blood pressure and I have entered it in just the right place. And then I must, before I can go somewhere else in the chart—perhaps to make a note that the patient just told me about her boss sexually harassing her—I must weigh her and I must enter that information in just the right place. Oh and then I must calculate her body mass index, and I must chart that I counseled her on the fact she’s too fat, and I must print patient educational materials telling her she’s too fat, then I must make her promise to discuss it again in the future, and I must choose a date to do just that and I must chart that, too. In just the right place. Then, and only then, am I “free” to leave that section of the chart.

And on and on and on it goes.

At first this overwhelming flood of exacting requirements and new must-dos caused some push-back from the medical staff, who just wanted to make patients healthier. Then one of the middle-management people posted this sign on the wall:

Relearn, Relocate, or Retire.

So literally, the writing was on the wall. Way to motivate the troops. Caesar would be proud, no doubt. Or Kadafi. Or Saddam. But the sign did its job. Dissent evaporated. We put our noses to the electronic grindstone, not even realizing that the soul of medicine had just been sacrificed on the Altar of Must.

After months of generalized misery and persistent blues, I awoke this morning to the realization that I’m not having a conversation with my patients anymore. I’m not learning who they are. I’m not understanding the victories and defeats in their daily lives. I’m not bonding with them in a way that they will share their darkest fears and experiences with me anymore. I am neither educating nor inspiring. I’m not motivating, and I’m certainly not healing. I’m just interviewing my patients and recording their answers like a court reporter, rarely even having time to look them in the eye.

Now, instead of a Medicine Man, I’m a fucking bureaucrat.

And that realization depresses me beyond my ability to communicate. Perhaps its time for me to find another line of work. But this isn’t just about me and my job satisfaction. There’s something larger at stake here.

As a society, we’ve been down this path before with No Child Left Behind, a perhaps well-intentioned piece of legislation that ended up creating an environment in which educators could no longer educate our children; and all innovation, inspiration, and creativity was squashed as our best, brightest, and most passionate teachers as they were forced to teach to the test. It fully industrialized schooling—ironic, given it happened in the post-industrial age.

It has destroyed all that was best about American education. If you don’t believe me, just ask any veteran teacher if she’s happier, more satisfied, or feels more effective now than she was before Every Child Was Left Behind.

Why did I bring this up? Because, like education, the healing arts can’t be industrialized. One size doesn’t fit all.

Because practicing medicine to the chart is just like teaching to the test. And it could be the death of us all.