The public voice of doctors

One of the selfish reasons I love being a physician is the honor of being included in such a respectable group. Doctors are good people, smart people, dedicated people. These are my colleagues, my mates, my fraternity.

This attachment to the honor of doctoring is why it pains me when we hurt ourselves with our words. When the public voice of doctors lacks grace or empathy or even a modicum of self-awareness, the profession, the group as a whole, is diminished. The digital age cuts both ways. On the one hand, its democracy gives regular doctors a voice, but on the other, it amplifies and makes permanent our missteps.

A recent op-ed in the Wall Street Journal stirred me to think about the responsibility physicians incur when they reach out publicly. Dr. Daniel F. Craviotto Jr is an orthopedic surgeon who submitted an essay to the editors of the WSJ. His Declaration of Independence piece, which urged doctors to defy health-care mandates issued by bureaucrats not in the healing profession, addressed many of the challenges in US healthcare delivery. Craviotto brought attention to intrusions to the patient-doctor relationship, the awfulness that is modern-day electronic health records, and declining reimbursement for doctors. All important issues for sure.

Yet, his essay, or perhaps one could call it a sophisticated rant, served to diminish the dignity of his colleagues, his fraternity, his team. Let me explain. It will take a few paragraphs.

Malcolm Gladwell recently advised doctors to tell their stories. In a Forbes interview, he said doctors should “help people understand what it is really like to be a physician.” The thesis is that health reform might improve if both the public, and reformers, understood the perspective of real doctors. Gladwell’s command of the obvious is striking. “You don’t train someone for all of those years of medical school and residency, particularly people who want to help others optimize their physical and psychological health, and then have them run a claims-processing operation for insurance companies.”

I agree with this idea. It’s one of the reasons I write about doctoring, and health policy, and it’s why I advocate that other doctors do the same. I’m no negotiator or problem-solver but it’s clear that seeing problems from others’ perspectives improves the odds for conflict resolution.

Consider, for instance, the specific conflict we are in with US healthcare. Here, I’d argue that the dearth of real-world physician voices has impeded progress. I regret waiting so long to engage in the conversation. I suffered from the bystander effect–my colleagues will keep up the advocacy; I’ll just keep ablating arrhythmia. I was too interested in doctor-specific outcomes, which is, in fact, part of the problem with healthcare delivery. (But that’s another topic.)

The thing about being a doctor and joining the public conversation is that it’s serious. Three sobering facts are true when a doctor reaches out publicly: 1) He or she represents the dignity of the profession, 2) People will listen, and 3) People will form intuitive perceptions. And you know the rule about perceptions.

Since we are talking about doctors and their public voice, it seems a good place to review word definitions. One of the definitions of grace is courteous goodwill. Tone is the general character or attitude of a piece of writing. Self-awareness is a noun for conscious knowledge of one’s own character, feelings, motives, and desires.

One of the things I’m most squeamish about is looking back at my early writings. (The truth is I’ve taken down a few of my previous posts, and I’ve edited others.) Why? The answer is that some of my words were tone-deaf, hyperbolic, and, when read from the perspective of others, devoid of self-awareness. A couple of hard lessons I have learned about self-awareness: I write often about health and the value of exercise. Readers quickly pointed to my luck in being gifted healthy lungs, legs and mitochondria. Endurance sports come naturally to me. I’ve taken that for granted. Another example comes when I’ve expressed opinion on declining reimbursement for what I see as valuable clinical skills. Again, readers taught me to consider doctors’ pay in relative terms. Simply said, we are compensated well, not only in dollars, but in self-esteem and public respect. It’s easy to forget that most sub-specialists are paid more in salary than the president of the United States.

Some might quarrel with where I’m going with this. “Hey, Mandrola, you have said that a doctor’s public voice should be candid and real and honest. Then you get sideways about an orthopedic surgeon who does just that in the pages of the Wall Street Journal.”

Perhaps I’m naive but I don’t think candor and honesty are opposing forces of grace and self-awareness. It’s just harder to write that way. Yet if we want to move health care in the right direction while maintaining the dignity of our profession, doctors who engage in the public conversation must be mindful to do both.

We won’t be perfect. We never are. But surely we must think hard about our words before hitting the send or publish button. I think my grandmother taught me that a long time ago.

JMM

Indiana University pediatrician and uber-explainer Dr. Aaron Carroll details the many flaws in Dr. Craviotto’s Declaration of Independence.

Update: Shortly after I published this post, my colleague in medicine and social media, Dr. Jordan Grumet, wrote this opposing view, Why I don’t agree with @aaroncarroll. Dr. G dissents, but in doing so with grace and self-awareness, he emphasizes my point.