The challenges in health care are constant and intense, but professional integrity and patient welfare must be held paramount.
THE recent Seattle Times investigative report “Quantity of Care” prompted a range of emotions in me. As a mother, I felt deep grief as I read about Talia Goldenberg’s heartbreaking journey. As a patient, I felt fear at the cold realization of how badly wrong things can go. But as a professional who represents physicians, I know from firsthand experience that the vast majority of physicians in Washington state are unwavering in their dedication to the well-being of their patients, which often comes at the expense of their families, businesses and even their own mental well-being. At the heart of the medical profession are deeply compassionate healers seeking to ease the suffering of their patients and to work with them to prevent future illness.
It’s a reality in health care today that the provision of care must coexist with the business of medicine. And there’s no question an uneasy tension begins where profits intersect with people. Even so, a guiding principle of providing care must be to put patients first.
The Seattle Times series underscores legitimate concerns about the practice of medicine in the current environment and has provoked a healthy public conversation in the days since it was published.
The series raises questions about medical professionalism, which is the cornerstone of the patient-physician relationship. That professionalism encompasses specialized knowledge and training, a formal code of ethics, autonomy and self-regulation. It requires an ultimate obligation to advocate for, and to serve, the specific needs of each individual patient and overall society. Medical professionalism and the Hippocratic oath bind physicians to the high calling of putting their patient’s interests and needs before their own.
Yet, dramatic and complex changes in the health-care environment have placed a strain on medical professionalism and on physicians’ ability to exercise independent clinical judgment. We must ensure that doctors’ professionalism and independent judgment remain protected, even in our quest to have a healthy bottom line.
Prophetically, more than 30 years ago, former University of Washington President Charles Odegaard foreshadowed these challenges to the profession in his book, “Dear Doctor.” “What we need above all now is a greater bond of faith and trust between patient and doctor, sufferer and healer, which is accommodated with whatever health care institutional arrangements emerge in our society,” he wrote. “We certainly do not want bureaucratic and technologic health factories devoid of practicing physicians who really care for their patients and devoid of patients who really have trust in their physicians.”
At the Washington State Medical Association, we can accept nothing that threatens or undermines the integrity of the patient-physician relationship. If our members are working in an environment that hinders that essential aspect of professionalism, if they feel that they have no control over their patients’ care, or they have no voice or safe space in which to raise concerns, then it is incumbent upon all involved to create a safe culture where physicians’ voices are heard and concerns are addressed.
The challenges in health care are constant and intense, but professional integrity and patient welfare must be held paramount. Our health care delivery system must foster an ethical health care environment. Health systems, insurance companies, the government, physicians, other providers and patients should uphold their obligation to sustained, intimate and trusting patient-physician relationships in which physicians can fulfill their ethical obligations to patients. Transparency is a must. Without it — as illustrated by The Seattle Times stories — there can be no trust, and without trust, quality of care suffers.