President's Page

President's Page
March 2004

Putting the excitement back in Medicine

by Warren E. Lichliter, MD
2004 DCMS President

I’ve thought about the things I could do tonight. There is precedent. I could sing. I could play the tuba. Neither would be very pretty. I could talk at length about public health—Dr Haley did. Tonight I will be brief. I need your help in solving my dilemma. How can I explain to the doctors of tomorrow why it is such a great time to be in medicine, and at the same time address the many frustrations of the physician today?

The other night in the OR…late again—sick patient, cancer, Medicare, multiple difficult procedures—all bundled, of course. The senior medical student on the case was wide-eyed and eager to learn the anatomy, the physiology, and the art of surgery. At the same time, the anesthesiologist continued to voice his frustrations over malpractice, reimbursement, and the uninsured.

I later voiced my experience to my wife. “Would you recommend a career in medicine to your children today?” she asked.

We all have heard or been a part of the whining in the hallway, the surgery lounge, or the meeting rooms. Malpractice reimbursement. Office expenses. Insurance hassles. HIPAA. Caring for the uninsured in the already overwhelmed ERs.

Statistics show a continued decline in physician satisfaction. In 2003, fully 25 percent of graduating residents reported that they would’ve chosen another career. In 2001, that number was only 5 percent.

We are going from practice-based medicine to a profession-based medicine, and the change is difficult.

Medicine used to be simple, safe, and ineffective—now it is complex, dangerous and highly effective. This change only heightens the frustrations of physicians today.

These issues that put the whine in our profession are complex. Most of these are economic or not centered on patient care. Even in areas that we know best, crises abound. The IOM report on safety, publication of outcome parameters, the pressing need for EMR, and interconnected information systems, and who pays for it are all issues that affect every patient we encounter.

Locally, we have significant potential problems with the Parkland budget, the uninsured, in- and out-of-county residents straining Parkland, community hospitals, and physicians, making it difficult to recruit new physicians into our community. Access to care for the insured is the next potential crisis.

My excitement tonight is that the situation has gotten so bad that it has to get better. I’ve always said that physicians will get involved with politics only when they feel the hurt. The hurt is here.

Physicians increasingly are aware of the importance of an organized and a unified message to legislators and the public. We demonstrated last year that great things can happen when physicians work together with a focused message—Proposition 12 became a reality.

DCMS represents 80 percent of physicians in Dallas County and is the third-largest county medical society in the nation. TMA is nationally recognized for its effectiveness and AMA for reinventing its relationship with specialties. Medical students are joining in increasing numbers.

My excitement tonight is that we can see the possibilities of success. All of us here tonight— physicians, politicians, business leaders, hospital systems, the public—have an obligation to build a consensus around these issues. The solutions developed will help define health care in the future. Through our efforts, this organization can be a meaningful voice at the discussion table.

Lastly, my excitement is that by letting our organization advocate at the political table, the physicians get back to the reinvention of clinical medicine. We have got to get to simple and safe and highly effective medicine. On the way there, we can get to a practice of medicine that answers the question of why we chose medicine years ago.

My anesthesiologist…can we take his frustrations away? Twenty years ago, the anesthetic risk was 1:10,000. Today, it is 1:250,000. He needs to feel good again about his excellent care. He, like all of us, should remind ourselves daily to serve as mentors to medical students like the one from the other night—not distracters to the joys of patient care.

My patient the other night did well—no more therapy and back to eating cheeseburgers.

My student is eagerly awaiting the match—and, I hope, an exciting career in surgery.

My anesthesiologist—can we work together to put a smile back on his face?

With the cooperation of everyone here tonight, I think we can.

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