American doctors have it rough these days. Not only are they fighting to keep Covid-19 patients alive as hospitalizations surge, but they are also struggling to navigate the ever-changing and increasingly complex world around them.
This generation’s doctors are not just dealing with medical issues, but with the health consequences of societal issues, as well. From gun violence and climate change to economic disparities and racial inequalities, the difficulties patients face in their communities are now entering the doctor’s office and banging loudly on the exam-room door.
Our guest this episode has observed these changes firsthand, and she joins us to offer insights into these confusing times for doctors.
Dr. Leana Wen is an emergency physician and a public health professor at George Washington University. She’s also a contributing columnist for Washington Post and an on-air medical analyst for CNN. Previously, she served as Baltimore’s health commissioner.
Highlights from this interview with Leana Wen
1. On treating the health consequences of society’s problems
“I remember back in my medical training, being told by attendings that there are certain things that we just should not be asking because, and so the thinking goes, what are you going to do if you get an answer for which you cannot help that patient? For example, what if we find that a child is coming in all the time for asthma attacks, but the problem is that he is living in a house that has vacant (buildings) all around, and there’s nothing that you can do about the mold in other people’s apartments, and that’s actually what’s triggering his asthma attacks? Well, at the same time, if that’s what’s making him ill, isn’t it also our responsibility as physicians and as healthcare workers to tackle those issues, because that’s ultimately the root of his illness? Otherwise, we’re only addressing the symptoms and not the cause.”
2. On whether doctors truly treat all patients the same
“We do in medicine, of course, we need to uphold our oath. And part of that oath is treating everyone with the same dignity and humanity, no matter who they are, what they look like, whether they’re able to pay. We treat everyone with the humanity that we would want to be treated with ourselves. That does not mean, of course, that everybody gets exactly the same treatment.”
3. On whether doctors do everything they can to save lives
“It’s often been said that public health works when it’s invisible. By definition, you don’t see the face of public health because we have been successful when we have prevented something bad from occurring. But then as a result, we don’t focus on prevention. Public health and prevention efforts are the first on the chopping block whenever we’re discussing budget issues. They are certainly not front of mind for many people. And one could argue, that’s how we got into the mess up we are today with this public health catastrophe, because we did not invest in public health infrastructure … And I hope that if there’s anything that COVID has taught us, it’s the attention to these long-term issues, including to prevention.”
4. On factoring a patient’s financial situation into medical decisions
“In my view, we need to do what’s best for our patients, recognizing that we do not live in a perfect world. In an ideal world, we should not be rationing care. In an ideal world, we should not be making decisions based on costs, but based on science and evidence. But we don’t live in that ideal world. I don’t want to be prescribing my patients a medicine for their high blood pressure that they’re never going to take simply because their insurance doesn’t cover it … I also think it’s very difficult when we tell our patients to do things like exercise or eat fresh food, but they live in a place where they can’t access fresh produce. And so we need to come up with recommendations that people can actually do. And so to the issue of cost, I do think it’s important to have a discussion with our patients about cost because they live in the real world.”
5. On whether docs should “stay in their lane.”
“When I was a medical student, I was very involved in the American Medical Student Association. I was on the board of directors. I also took a year off from medical school to serve as the AMSA national president full-time I worked in D.C. And at that time, I was trying to press the rest of the medical profession to this understanding that there is no such thing as ‘staying in our lane,’ that because our patients are coming to us with all these complex needs, and because we see that all these issues are intricately intertwined with health, that we need to be advocates for our patients on all these issues. Of course, over time, I’ve seen the limitations of this kind of view and in a couple of ways. One is that if everything is a priority, nothing is a priority.”
Fixing Healthcare is now in its fifth season, which focuses on the culture of medicine. For Dr. Robert Pearl, this topic is of vital importance to the health and well-being of patients. For years, he has been researching and reporting on physician culture—efforts that will culminate in the publication of his 2021 book, “Uncaring: How Physician Culture Is Killing Doctors And Patients.” To learn more, subscribe to his newsletter Monthly Musings on American Healthcare.
* * *
Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.