As 2021 passed into 2022, I was hoping new stories would emerge and dominate the medical landscape. So, I did a bit of crowdsourcing on social media and among colleagues. Here are five topics I’d like to read less about — if for no other reason than they’ve been discussed and vented ad nauseam with little likelihood of resolution unless words give way to meaningful action.
COVID-19
We’re rapidly approaching the three-year mark of this pandemic, with more than 300 million confirmed cases of COVID-19 worldwide and approximately 5.5 million deaths. The outbreak has been so dramatic that the World Health Organization needed to change the y-axis scale of their epi curve, prompting one advisor to comment, “In 30 years working on infectious diseases,we have not seen an epidemic curve like this before.” At the height of the Omicron variant, the U.S. topped 800,000 cases of COVID-19 per day, and the number of total deaths has exceeded 850,000 — many of which were preventable by vaccines and other measures. Infectious disease expert Perter Hotez tweeted that COVID-19 was “death by antiscience” — a true national tragedy. One outraged columnist lamented, “We now live in a world where we continue to make adjustments and accommodations for people who have no regard for the greater good.”
Bottom Line: The challenge to us as a society is to figure out how we live with COVID-19 so that it causes the least disruption to our daily lives. But as long as one person’s beliefs and comfort outweigh all others, needless hospitalizations and deaths will continue.
Burnout
Stories of overworked and burned-out health care providers were in the news long before the pandemic — and burnout seems to be on the rise as the number of physicians employed by health systems has swelled over the last several years. In recognition of the problem, health care organizations have begun to institute wellness programs and hire chief wellness officers.
Meditate and be mindful all you want, but no amount of supportive therapy will cure what really irks American physicians — loss of autonomy and pride in the profession. Throw in cumbersome and time-consuming electronic medical records, longer working hours, preauthorization requirements and reimbursement hassles, and you have the recipe for a malcontent doctor whose resilience has reached the limits of a balloon about to burst.
Bottom Line: Unless physicians rediscover the joy in practicing medicine and find purpose and meaning in their work, their ranks will continue to be demoralized and depleted. If organizations only pay lip service to wellness initiatives, they will not achieve their clinical or financial goals, and their reputations will suffer.
Health disparities
Pandemics have a way of exposing health inequities, and COVID-19 has been no exception. Black adults are more likely than white adults to report certain negative health care experiences, such as a provider not believing them and refusing them a test, treatment, or pain medication they thought they needed. The fact that anyone could receive inferior treatment due to the color of their skin, ethnicity, religion and even sexual identity and orientation is appalling.
Furthermore, social determinants of health — factors like socioeconomic status, education, neighborhood and physical environment, employment, social support networks and access to health care — affect a wide range of health, functioning and quality-of-life outcomes and risks.
Public health organizations and their partners in sectors like education, transportation and housing need to take action to improve the conditions in people’s environments. States, local communities, private organizations and providers must also be engaged in efforts to reduce health disparities.
Bottom Line: Health services must be adapted to be attentive to and capable of treating culturally diverse patients. Although there is a blueprint for achieving overall health and well-being by 2030, we’re running dangerously low on laws and policies that provide equal protection for all.
Racism
Workplace discrimination and mistreatment has been commonly reported by medical students and residents across multiple specialties. More subtler forms of racism and discrimination — microaggressions — are indirect expressions of prejudice that contribute to the maintenance of existing power structures and may limit the hiring, promotion and retention of women and underrepresented minorities in medicine.
Given the increasing diversity of the general population — people of color are projected to make up over half of the U.S. population as of 2050 — we must not fall into stereotypes of what a doctor, nurse, medical school professor or researcher should look like. We should require all health care workers to have basic cultural safety and anti-racism education so that providers do not have to deal with micro and macroaggressions daily.
Bottom Line: Rectifying the legacy of imperialism and racism is imperative. Physicians can overcome their prejudices by becoming more aware of them and coming to terms with their past.
Health reform
Health reform has teetered on the brink of collapse for decades, leaving a plethora of patchwork fixes in its wake. To curb health care spending, leading economists have proposed the “1% Steps for Health Care Reform Project” — 16 proposals that each underscore a problem in the U.S. health system that incrementally raises health spending approximately 1 percent yet without commensurate gains.
If resolved, hundreds of billions of dollars annually could be saved (approximately 9 percent of overall health spending). The proposals address pharmaceutical spending, health care fraud, surprise medical billing, hospital consolidation, claims adjudication, health insurance choice and others. Some proposals will require federal intervention, some will require steps by state-level policy-makers, and others will require interventions by payers and providers.
Bottom line: Fixing what ails the U.S. health system requires a seismic shift in the way we think about health care spending and allocate dollars for services. If Congress wants to meaningfully address health spending, they must stick to their job of putting people (patients) first and disregard the financial consequences of policies that adversely impact players in the health system deemed nonessential.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.
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