My Response To The NEJM

This is a not exactly line-by-line response to this essay in the NEJM.

I am not racist.   I can find evidence that I am not – my career dedicated to caring for all people regardless of color or religion, and my support of all colleagues and trainees.  My mission as a physician is to be humble and respectful toward all of my patients, because that is the mission of all physicians.   I am not racist because I was shaped by a society that listened to the words of Martin Luther King, a society that aims to judge people by the ‘content of their character’, not the color of their skin.  I mean this not as an admission of pride, but as a call to all physicians. 

Unfortunately inequities exist in all aspects of any society as large and heterogenous as ours.  To counter these inequities, there has been a dramatic manifestation of structural support built within our society.  So what am I, a pulmonary critical care physician, doing about the overwhelming burden and mortality of ARDS, sepsis, and drug abuse?  How am I confronting the underlying forces that facilitate the suffering of all patients that come to the ICU?   What is necessary is for me to provide respectful care to all patients I encounter, with absolutely no attention to their race, religion, or social background.

If I truly want to remain part of the solution, I need to continue to explore the parts of me that drive me to be the best physician possible.  My goal is to serve each patient equally, with the best judgement and care they deserve as an individual, not as a member of a group.    

I am never tempted to run in the other direction from the care patients require.  I spend time with patients as their situation demands, whether that is ten minutes with the nonsmoker back for an encouraging CT report about a benign lung nodule, or sixty minutes with the son in the ICU trying to understand what his mother’s diagnosis of anoxic encephalopathy means.  My clinic schedule is based upon why patients need to see me and when, and I then decide interventions based upon their clinical issues.  It is important to recall that the key in medicine is the patient comes first. 

It takes courage to practice medicine, to take on the responsibilities of others in need and have the energy to remain focused on what is important and essential in their time of vulnerability.  Fortunately the US health care system is made up of physicians who honor this calling every day, which makes our country a medical destination for patients from all over the world.  These patients from within our country and abroad know that they will receive thoughtful care supported by the latest innovations, with fairness and attention.  Is the US system perfect?  No, not even close.  But that is despite, not because, of the people on the front lines who interact with patients every day.  Our imperfections are seen in the maze of insurance obstacles and administrative redundancies that have metastasized into an almost uncontrollable force working against the relationship between physician and patient.

I do not know any physician that has shame in their occupation.  I acknowledge my privilege; that the ability to have reached a position where others depend upon you for their health is a privilege unequaled in almost any other profession.    I commit to a process of continuing to put my patients first, but need to also remember to preserve my own health and energy.    The practice of medicine is physically and emotionally challenging, and doctors need to take care of themselves to avoid the psychological pitfalls of daily patient care.   If physicians are to heal others, we must always remember to heal ourselves.