Lamentations for Expectations

As a young primary care internist, I fully bought into the expectation that doctors were at the beck and call of their patients and had a responsibility, regardless of reimbursement, to care for them 24/7.

Later in my career, I worked as a hospitalist, where I felt a strong obligation to serve as the primary care provider for those patients on my service in the hospital. I called the shots re-treatment, testing, consults, etc.

At the age of 65, I left clinical practice when the pandemic began to hit hard. For most of my life, my self-image had largely been synonymous with my profession. Consequently, I lamented the need to do so.

Now I fear that my younger colleagues, still working diligently on the front lines of healthcare, have also bought into the expectation that doctors should have no limits to their commitment to patient care. Many of them are burdened with large amounts of educational debt, and the life and death decisions they must make daily, especially during the pandemic, are nearly impossible for most of us to imagine. The system they work in has demonstrated time and time again that profit is more important than providing high value (quality per unit of cost) to patients.

We need to be careful because there has to be a limit as to how far we can expect healthcare providers to sacrifice and try to live up to unreasonable expectations. As the pandemic seems to be abating (fingers crossed), we need not be complacent and assume that physicians are willing to step up to the plate again when the next surge in the current crisis or another crisis altogether comes along.