On assembly-line medicine.

To be totally honest, I wasn’t quite sure what osteopathic medicine was when I was applying to medical school.

I knew that osteopathic physicians had the same training and qualifications as their M.D. counterparts with some additional education in osteopathic manipulative medicine (OMT). When I started to research more into D.O. schools and what it meant to be an osteopathic physician, I was inspired. I loved how the osteopathic philosophy had a holistic approach to healing and understood the importance of the body’s innate ability to self-heal. I thought it was amazing that there was a whole group of physicians that believed in treating the body, mind, and spirit of each patient. For some reason, I had a belief that osteopathic physicians weren’t the type of people to work assembly-line physician jobs.

During my first couple of years at an osteopathic medical school, the inspiration continued. Though I never considered myself good at OMT, I loved working with my hands and having an extra tool to address somatic complaints. I practiced my skills outside of the second year lab on friends and family and felt rewarded when I resolved their neck pain or back pain. I started treating my own TMJ dysfunction with OMT and improved some jaw pain I was experiencing from stress-induced bruxism. OMT served as an exciting escape from the mundane pharmacology and microbiology facts we were forced to memorize. I couldn’t wait to see how OMT was being practically used in the clinics.

When I started rotations, I went to my first clinic full of excitement. I was finally going to see an osteopathic physician practicing in the way I hoped to one day… Or so I thought.

I saw a very different side of what I had imagined. My OB-Gyne preceptor spent about 5 minutes with each patient and saw an average of 50 patients during her clinic hours from 9am to 6pm. She often had to cut her appointments short or cancel them fully due to having to run to a delivery at the hospital nearby. Patient wait times ranged from 1 hour to 4 hours. Patients often had many questions about prenatal care and concerns about delivery planning that were not adequately addressed. The patients with chronic diseases often got education regarding their condition in the form of a handout and a short 1 sentence explanation.

Once I had improved my history and physical skills, I was allowed to admit a woman who was recently diagnosed with gestational diabetes. The pregnant patient was understandably concerned about the effect of medications and her uncontrolled blood sugars on her future child’s health. I spent 20 minutes talking about an ideal diabetic diet and the importance of exercise with her. When I walked out of the room, I was scolded by the medical assistant for spending too much time in the room which was needed for other patients. My preceptor told me that I should never be spending 5 minutes with each patient. “Prenatal care doesn’t require much. Just follow the protocols”, my attending physician said.

Instances like that happened often. I volunteered to do OMT on a patient who complained of a headache and was criticized again for spending too much time with the patient. I was offering something outside of the protocol, which seemed unheard of at this clinic. Patients who revealed their emotions often received a manufactured “Hang in there, it’ll be alright” from my attending physician and given a tissue while being escorted out of the exam room. It seemed that exam rooms were worth more for the revenue they could generate rather than the problems of patients they could fix inside of them.

I went home often feeling frustrated and defeated. My idea of what an osteopathic physician was so different than what I had experienced. I thought the benefit of attending an osteopathic versus allopathic medical school was to have mentors that treated patients holistically and addressed their complaints with new approaches. I thought that OMT was something that I would be allowed to perform at my rotation sites. I knew doctors did not have limitless time to spend with patients, but I thought they would be doing a better job of addressing psychosocial components to their conditions.

After some more insight into my OB-gyne preceptor’s corporate employer, I began to understand that she wasn’t practicing her idea of ideal medicine either. On a late night in between deliveries, she admitted to me that she was frustrated with her patient load but felt helpless. She didn’t have a choice rather than to stay in her assembly-line medicine job because of the medical school debt she was in. She was in a position where she had to rotate through patients daily, rather than spend quality time with them. She knew she wasn’t providing the best care to her patients as possible, but she felt stuck.

I left that rotation seriously questioning if medicine was the right path for me. I didn’t want to be in a practice like the one I had seen. I thought assembly-line medicine was the only option for me but I  knew wanted to have plenty of time with each patient and perform services outside of the protocol. I didn’t think that was still possible until I got involved in advocacy for the single-payer healthcare system in the US and the ideal medical care movement.

My call to action to people frustrated with the current state of the healthcare system is this: realize that you’re not alone. Assembly-line medicine is not the only option. I’m discovering daily that there are more and more people that are tired of medicine becoming a corporate entity and determining a physician’s every move. I realize that I can use my voice to make a difference and practice medicine in the way I had dreamed of.

For more information on single-payer check out my previous blog post and http://www.pnhp.org/facts/what-is-single-payer

For more information on the ideal medical care movement check out http://www.idealmedicalcare.org/

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