I reached a tipping point today. Instead of seeing patients who are hurt and could use my care, I spent the entire day training in yet another electronic medical record system designed with good intentions, but poorly executed. I felt as though I was building my own cage, one in which I will be intently shuffling paper and clicking tabs to comply with administrative regulations instead of laying hands on the sick and hurt. I took the Hippocratic Oath, damn it. It directs me to first Do No Harm — but its corollary is to do good with the knowledge I have been privileged to obtain.
I went to medical school with the idealistic notion that being a doctor meant I would spend my days helping people in their time of need. I thought it meant I would help cure patients’ acute ailments and empower them with education/guidance about health and wellbeing. But medicine seems to be shifting away from a healing art supported by an ethical societal obligation. Now, it is co-opting wellness for business opportunity. As our priorities have shifted, the conversation has changed from best health practices to cost-saving, and money-making opportunities. On a daily basis, I feel the tension between shuttling patients through clinic to achieve personal and institutional financial goals and taking the time I need with patients so that they might be fully seen, heard, and appropriately cared for.
As a system, we are out of integrity. We are supposed to be proponents of health. But health includes prevention and education, not just patching what is already broken. It includes not only supporting our patients and communities, but taking care of ourselves so that we can continue to do good work. It also means implementing a system where physicians can openly share ideas and learn from mistakes without fear of legal retaliation or professional shame. The standard of care seems to have been titrated to infallibility for doctors who have dedicated much of their lives to the service of humanity. Medicine is a creative, dynamic profession and yet we are asked to operate within archaic technological systems, enveloped by fear of scrutiny and retaliation for our medical decisions.
We need a shift. As a community, we need to decide: Do we want to enslave ourselves to litigiousness and financial greed — or do we prefer to use our hard-earned knowledge and clinical acumen to make the best decisions for the patients for whom we care?
We are living in 2019 with patient care technology that reminds me of the Apple computer my parents brought home in the 1980s. In a time of artificial intelligence and virtual reality, why am I stuck with clumsy drop-down boxes and multiple clicks for every piece of patient data? My children use computers to build cities and practice tennis, all with a remarkable resemblance to those activities in real life. Pilots practice their craft using dynamic simulators. And yet my physical practice and surgical learning is relegated to the living human body in the surgical suite? Where are our skill simulators? Where are our smart systems?
I think these are problems with solutions, and I intend to be a part of those solutions. I want to consult with technology companies to develop tools and systems that facilitate our work. I intend to write and speak about the beauty and potential of what we, as physicians, can offer. I intend to continue to authentically and generously serve my patients. I will continue to practice with integrity. It is a privilege to serve, and we can do better.
Alessandra Ross is an orthopaedic sports surgeon, war veteran, mother, and humanitarian. Her professional work has brought her to underserved communities and austere environments. As a result of these experiences, she has become passionate about equitable and efficient health care systems, and promotes technology that can help us create this reality.