When plastic surgeon Dr. Robert Pearl published his Los Angeles Times op-ed,“医生文化如何沉没美国的医疗保健”他对像我这样的初级保健医生的辩论论文，引发了一场大火。当他提出一些有效的观点时，珀尔博士还指责美国的许多预防健康失败直接归功于初级保健医生的肩膀，而没有承认我们的医疗保健系统和我们的美国生活方式已经创造并加剧了其中许多确切的问题问题。我和我的医师同事试图将患者引导到健康状况，但常常让我们感觉像Sysiphus。像Pearl博士在文章中所做的那样，要归咎于美国的医疗保健混乱，对美国人没有帮助，也没有帮助初级保健医生。
我同意Pearl博士的观点，即美国医疗保健面临系统性的官僚挑战。我的列表比他的清单更长，但同样的是，包括EMR图表，事先授权和不断扩展的质量指标列表的磨削任务。大多数初级保健医生在办公室图表外花费数小时，接听电话和电子邮件，并让家人参与讨论，以提供最佳的患者护理，即使这次既没有薪水也没有得到薪水的补偿。询问在Covid期间工作的任何初级保健医师，您将学习这些电子邮件和电话仅乘以有关COVID症状，治疗和隔离的问题已成为常态。
Dr. Pearl is also correct that several Americans who died from COVID had chronic, preventable diseases which contributed to their demise. He is correct that preventing disease is undervalued in current fee-for-service health care models. However, Dr. Pearl is sorely mistaken in saying that American physicians are an “equally large part of the problem” because they did not dedicate enough “time and effort to preventing and … managing these types of chronic diseases.” He is wrong in insinuating that the majority of American physicians don’t value preventative medicine because we don’t prioritize it or see it as “heroic” enough to spend time on. It’s impossible to address chronic care, acute care, and preventive care in the standard 15 to 20-minute visit, including talking to a patient, doing an exam, refilling medication, charting, and completing a checklist of insurance company-mandated requirements. I might find 5 to 10 minutes to counsel them on diet, sleep and exercise routines, but then I might get penalized for this by running behind in clinic, which leads to patient complaints and negative Press Ganey reviews.
Dr. Pearl unfairly blamed “tens of thousands” of hospitalizations on primary care physicians, many of whom were on the front lines from the early days of the pandemic, practicing through challenges such as inadequate PPE and significant pay cuts in exchange for risking and all too often失去生命。我什至不会介绍我们联邦大流行反应的缺点，以及同时导致急剧急剧丧生的虚假信息的祸害。188亚洲真人体育但是，我将断言Pearl博士严重低估了我们社会和政府在慢性病中扮演的角色的重要性。
内科医生是否应归咎于患者经常负担不起的胰岛素（例如胰岛素）的高昂成本？当我们的政府时，家庭医生是过错的subsidizes堵塞红肉，使其比有机农产品更实惠？当患者呼吸时，内城儿科医生负责polluted air that exacerbates their asthma？贫困带来的孕产妇健康差异是否应归咎于产科医生？许多美国人长期压力，育儿不足或必须工作多个工作来养活自己，因此无法找到时间运动，烹饪健康的饭菜或获得足够的睡眠，这是医生的错吗？Pearl博士需要仔细研究美国公共卫生指标和健康的社会决定因素。这些健康的社会决定因素不仅仅是流行语，因此所有美国人都应该使用，因为没有他们的初级保健医生经常会与艰苦的战斗作斗争。
I also could not help but ask, “Et tu, Brute?” Dr. Pearl could have made his point without kicking his colleagues while they were down, overworked, and burned out. He did not have to contribute toanti-physician media bias。都是初级保健医生完美?当然not — the heartbreaking story Dr. Pearl shares of a friend who passed from ovarian cancer is just one example — and we all know there are others. We have room to grow. But we also face enormous challenges: Health care has become a service industry while many doctors still see themselves as scientists. Scientific facts have become politicized, and expertise of all types has become devalued with the advent of Google. Our jobs are constantly encroached upon by physician extenders with less training as we gradually lose our autonomy to profit-driven executives. Yet primary care physicians still, despite all of the above, love to take care of people. In fact, we in primary care go into hundreds of thousands of dollars of debt to make modest salaries so we can answer a calling to heal and help.
Should physicians have better training in palliative care and how to communicate with patients? Yes. Should academic medical centers admit more primary care residency spots? Yes — yesterday! Should all physicians treat their patients just as they would their own families? Yes. So many of them already do. Let’s be fair and honest about what needs to change and improve. Let’s also call on elected officials to reduce barriers to healthful living. Our health care system is suffering, and so are patients and physicians. COVID has shown us what has been behind the curtain all along. Physicians need to work together to preserve our profession as one we would want our children to pursue. The future of health and health care is at stake. Dr. Pearl made some good points. He did not need to attack and unfairly blame his colleagues to make them.
Sheetal Khedkar Raois an internal medicine physician.
Image credit:Shutterstock.com
