Change is a reality in all aspects of life and all fields of medicine. Neurosurgery residents are being trained in responsibility and patient care, however, the system itself is changing almost continuously. Understanding these dynamics is crucial to endure a career in medicine. Challenges include the intersection of technology and health care, understanding and modulating the “business” of medicine, and getting control of the medical-legal system.
To start, it is important to recognize that patients are better versed about their health care and diseases these days, thanks to public advocacy and the internet. Vanishing are the days when the “doctor knows best.” Today, patients shop for their physician, looking for the most cutting edge surgeons, performing “minimally invasive” procedures while remembering their names. These highly sophisticated patients are raising the bar for physicians, encouraging them to stay ahead of the times in their field. In the same vein, technology has become increasingly intertwined with patient care. Be it the medical records system, vital sign telemetry, functional non-invasive imaging or computer guided surgery, the marriage of medicine and machines is evident. Residents exposed to this early on will acquire the skill sets necessary to work in this environment. Physicians who embrace this technology will be rewarded through more efficient and thorough patient care.
The business of neurosurgery is constantly changing, usually with more restrictions and decreased reimbursement. Given the recent legislature, it seems that our nation is on its way to “universal healthcare.” Whether equal health care to all US residents becomes a reality is a different issue. Judicious spending and electronic records can facilitate this possibility. However, without addressing malpractice law and tort reform, the solution will never be achieved.
As a result of economic and training constraints, it is clear that the field of medicine has shifted from generalists to specialists with an emphasis on “Centers of Excellence” and multidisciplinary efforts in patient care. This allows more efficient and cost effective delivery of health care by more experienced specialists. Conversely, specialists in the community are focusing more on bread and butter cases and are occasionally criticized when they go “above and beyond” their institution’s capabilities. For example, fewer patients with aneurismal subarachnoid hemorrhage or severe brain injury are treated in community hospitals. This centralization of medicine will be essential in maintaining the highest level of care available to Americans at a relatively affordable cost.
The complexities and inequities of the health care system have deterred many people from entering the field, compared to previous decades. As a result, the remaining physicians are more motivated and willing to work in this environment. As we graduate from residency, it will be on us to change our field. Embracing technology promoting efficient informatics and inter-physician communication will be key. Equally as important is communication with our patients, not only articulating diagnoses, risks, and surgical interventions, but also encouraging tort reform and legislation change. Of course, the underlying tenet of improving quality while reducing cost will guide our progress. Ultimately, putting the patient before everything else is the recipe for success.
Garni Barkhoudarian, MD
Department of Neurosurgery, UCLA