- How monumentally undereducated/misguided about health/medicine/ethics the people legislating health care are.
- How desperately most physicians avoid thinking about the problem; indeed, how many actively contribute to it in order to chase "patient satisfaction," the end-all-be-all these days in the highly political hospital world.
- How mercilessly this hurts patients, particularly the underserved.
2) How uninvested most patients are in their own health.
- How lazily most people would rather take a pill to control their obesity or cholesterol instead of watching less TV and getting up to exercise.
- How massively undereducated people are about basic nutrition facts that didn't have to be explained to their ancestors just a few generations ago.
3) How uncertain the practice of "the standard of care" is.
- How traditionally defined practices that legitimately may negatively affect patient care still survive. "This is how I was taught" is something I've heard way too often.
- How evidence-based medicine struggles to make the rounds, as many have relatively little experience analyzing a study and how it should or should not affect their practice.
- How tremendously difficult it really is to actually prove something of clinical value, namely due to the fact that ethically, experimentation on humans is seen as horrifyingly unethical ... but at a certain point, you have to wonder if it's not just as unethical to keep up practices that we're not really sure are beneficial to the patient.
4) How minimally the process of educating a clinician has changed to adapt to modern times. Indeed, one wonders if we aren't going backward somewhat.
- How ancient the system is, expecting every medical student to take the same courses/rotations for three years and then somehow differentiate themselves into the 145 different medical specialties. This originates from a time when it was legitimately possible to know just about everything in the field of medicine with enough time/study.
- How favoring the system is to subservience, now that we have the hierarchy of attending physician, fellow, resident, medical student.
- How frightening it is that we emphasize memorizing and spewing out answers on tests instead of looking at ways to test actual clinical competence.
- How poorly the art of the physical exam is taught, in favor of far more expensive tests and imaging.
All that said, I still love what I do. There is much I would change if I had the power, but simply put, I do not; nor, I suspect, will I ever. So I do what good I can, when I can, where I can. We'll see if any of this changes in the years to come.
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