Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Society’s health should not be doctors’ responsibilities

Justin Reno, MD
Physician
December 8, 2015
Share
Tweet
Share

I thoroughly enjoy my 65-year-old male with his horrendous diabetic foot ulcer.  But there’s not enough insulin in the state of Tennessee to cover the two bacon, egg, and cheese biscuits he eats every morning.

And I adore my 57-year-old female with COPD.  But the inhalers won’t work until she stops smoking two packs of cigarettes per day.  I laugh every time I see that hilarious 32-year-old with hypertension.  But the ACE, calcium channel blocker, and diuretic won’t overcome the cocaine he does every day.  And the 42-year-old female that already has cirrhosis?  Her smile lights up the exam room.  But her liver won’t improve until she slows down on the 12-packs.

Fast food companies can make it seem so fun to eat an extra meal, but it’s my job to deal with the obesity.  Cigarette companies can make smoking seem so sophisticated, but it’s my job to salvage the lungs.  Beer brands can make it seem so glorious to drink.  But I have to deal with the devastation that ensues.

Modern health care feels that it’s my job, as a physician, to fix society’s health problems.  It’s really not.  My job, or at least what I’ve come to see, is to help guide people through their own health issues.  In the minuscule amount of time I get to interact with a patient (maybe 15 to 30 minutes every month), it’s impossible for me to overcome the habits/decisions they make all day, every day.  Especially considering how often they’re bombarded with the advertisements of the things that harm them the most.

Think about it.  Society’s health is my responsibility?  Nope, it’s really not.  Society’s health is society’s responsibility.  Physicians are a very small portion of society.  My health is my responsibility.  My patients’ health is their responsibility, despite the fact that I lose sleep over them constantly.  Despite the fact that I’m woken up at all hours to help take care of them.  But in the future, I’ll probably be “graded” by how many of my patients’ A1cs are at goal.  I may even be paid by how many of my patients’ blood pressures are better than 140/90.  I’ll be paid for my performance according to certain business metrics.

So that 65 year old with the diabetic foot ulcer?  Probably going to lower the grade.  He’s told me how much he loves his breakfast sandwiches.  And the 57 patient with COPD?  Still my patient, and I’ll counsel her every office visit, but she’s told me she’ll die with a cigarette in her hand.  The 32 year old?  I’m going to give it my best despite probably getting paid less.  And the 42 year old who drinks?  Yep — I’ll see her as often as I can, and do whatever I can, but she’s not going to make my health outcomes look any better.

It won’t take long for physicians to figure out health care “grade inflation.”  Most physicians mastered grade inflation long before high school.  Health care grade inflation is rather simple: Just cut out the unhealthy portion of society.  Cherry pick the patients that take responsibility for their own health.  It’s so much easier to control a patient’s diabetes if that patient follows their recommended diet.  Lungs clear when the cigarette assault stops.  Livers regenerate after successful rehab.

The obvious problem is that nobody will want to take care of society’s sickest.  The smokers, the alcoholics, the fast food addicts, the drug addicts — those are going to be the ones that suffer — the ones that require the most but yield the least results.  The ones that honestly need physicians.  And the physicians that truly care about them are going to have the lowest grades.

They’re patients.  They’re people.  They’re human.  They’re the reason why I got into medicine.

And they are not business metrics.

Justin Reno is a family physician.

Image credit: Shutterstock.com

Prev

Tell Uncle Sam to go easy on older doctors

December 7, 2015 Kevin 10
…
Next

Reducing hospital readmissions: The burden shouldn't be all on the doctors

December 8, 2015 Kevin 17
…

ADVERTISEMENT

Tagged as: Diabetes, Primary Care

Post navigation

< Previous Post
Tell Uncle Sam to go easy on older doctors
Next Post >
Reducing hospital readmissions: The burden shouldn't be all on the doctors

ADVERTISEMENT

More by Justin Reno, MD

  • I don’t know if this test will save your life

    Justin Reno, MD
  • If you’re obeying the law, you’re contributing to CEOs’ astronomical salaries

    Justin Reno, MD
  • What this family physician learned from his dog

    Justin Reno, MD

Related Posts

  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • How social media can help or hurt your health care career

    Health eCareers
  • Sharing mental health issues on social media

    Tarena Lofton
  • Almost half of health care workers are not doctors and nurses. Health policies must address their burnout too.

    Irving Gold
  • Doctors and patients should be wary of health care mega-mergers

    Linda Girgis, MD
  • 3 ways to advance the credibility of online health information

    Robert Pearl, MD

More in Physician

  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Why compassion—not credentials—defines great doctors

    Dr. Saad S. Alshohaib
  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 110 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Society’s health should not be doctors’ responsibilities
110 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...