“Difficulties mastered are opportunities won.”
– Winston Churchill
We are living through challenging times. Our profession, our medical systems and our personal wellbeing are under unrelenting pressure to change and to adapt. Physicians are tasked with seeing more patients in less time, while maintaining high satisfaction and responding to systems that rate our performance and patient’s satisfaction with those visits. Increasingly, metrics are being applied to us all to judge the quality of the care that patients receive. We are expected to administer care more economically, more efficiently, with fewer complications, and with fewer resources. Penalties accrue to us in the form of public commentary on our care and abilities, financial penalties, opportunity costs in time lost with family and friends, and buyer’s remorse when we consider alternative careers that would have been more lucrative or more rewarding. Many would say that not only are physicians no longer on a pedestal, but rather down on their knees. Challenging times indeed.
All things evolve, including medicine. It is time to take a fresh, hard look at the way we practice medicine, and reform our medical system into something more effective and efficient. We cannot continue to do things as we have always done. We need to consider the impact of our actions on the medical system we share with our colleagues. We need to consider how our choices will impact the viability of our system. As a surgeon, I am keenly aware of the value of operative time, conscious of that fact that my colleagues will need my room and the resources I am utilizing to perform the same service for their own patients after I am through. I try to discharge patients as efficiently as safety allows, to free up beds for those of my colleagues who may need those beds for transfers. I endeavor to ensure that VTE prophylaxis is given so that my patient’s do not need readmission through our ER for a preventable condition. We need to be good stewards of our resources – which more than ever are limited and precious. But we do not need to go this alone. We have the experience and expertise of like-minded colleagues who have journeyed similar paths already, and are willing to share their experience with us in the form of best practice guidelines. We need to rely less on personal experience and expert opinion and more on best practice.
I remain optimistic about the future. Fourteen years working at Stanford has only reconfirmed to me what an extraordinary place this is. We have extraordinary capacity to adapt and to change, and we have wonderful partners in the Hospital and the School of Medicine who share this vision and this optimism. David Entwhistle and his team are working diligently on the aptly named “Project: Renewal” – our new Stanford Hospital, which will add 368 private beds for a total of 600 patient beds on-site, a new Level-1 Trauma Center, an Emergency Department more than twice the size of our current facility, 20 new operating rooms and a parking structure with 900 spaces. Dean Lloyd Minor has chartered a new vision of health care. Precision Health will harness the power of big data to provide personalized patient care that is tailored to individual variations. Dean Minor has also confronted the dire problem of physician well being, which resulted in the creation of the Stanford Center for Wellness and Professional Fulfillment, under the leadership of our former Chief of Staff Bryan Bohman, and his colleagues Mickey Trockle, Mary Lou Murphy and Rebecca Smith Coggins.
It’s time for our profession to get off its knees and stand up. Stanford Medicine can and should lead the way. As we go forward, I encourage all my colleagues on the medical staff to reject pessimism and embrace the opportunities that change will present us to remake our medical system into something better and enduring. Get interested, get involved and share your expertise and insight. Bring attention to problems and challenges, but also bring viable solutions, and the energy to put those solutions into practice.
I welcome your partnership and hope you will join your colleagues who have already embarked on this path.