Do no harm: A moral imperative to be the change in healthcare

“Can you please come see Mr. S in room six? His nose is bleeding, and he is very angry,” the nurse calls.

Calls like this always pique my interest. It is 4 a.m., and my job tonight is to respond to in-hospital emergencies, distinct from the usual daytime chaos of managing up to 20 patients simultaneously. Tonight, I have the luxury of time — at least until another emergency arises.

When I go to Mr. S’ room, he is initially reluctant to speak to me. I explain that I’m concerned about his nose bleeding and want to do what I can to help him feel better. Though skeptical at first, he begins to open up. I stay by his bedside while nasal packing is placed, soaked, and removed; placed, soaked, and removed.

During this ritual of monotony, we talk. I learn that he is frustrated that there is no cure for his illness, that he feels his concerns and suggestions are repeatedly dismissed because his formal education only went through sixth grade, that no one seems to have time to listen.

His nose bleed stops. I look at my watch: it’s almost 5:30 a.m. He thanks me for taking the time to listen. I realize that tonight I was lucky; I had the time to listen.

When I entered the medical profession, I took an oath: The Declaration of Geneva Physician’s Pledge. As a medical resident, I have encountered numerous obstacles to upholding the seemingly simple, common sense dictates of this pledge.

The health and well-being of the patient are my first consideration. However, due to the current state of the U.S. healthcare system, I find that I repeatedly fall short of providing the care that patients deserve.

For me, the “minimal acceptable” standard of care isn’t encompassed by the abstract concepts of cost, quality, or value of care in and of themselves. Rather, it is doing what I know to be the right thing for every patient: providing the care that every human deserves.

Dr. Sachin Jain, president and CEO of CareMore Health System, termed this “radical common sense.” Truly caring for patients means listening to their values and beliefs, aspirations and frustrations — actions that current payment models do not incentivize.

Instead, we hope the healthcare quality metrics that we use will indirectly incentivize high-value, patient-centered care.

Will any healthcare quality metric show improvement because I spent more time than usual listening to Mr. S? Perhaps not, but doing so helped me understand the roots of his frustrations and earn his trust.

Does any healthcare quality metric reflect what is lost in patient care when physicians are forced to see an increasing number of patients with no more time in the day to do so?

I have significant moral distress about being part of a healthcare system that allows individuals to suffer from diseases that we have the medical knowledge and capability to manage and treat— a healthcare system that robs me of the time to heal by listening.

However, I understand that there are significant hurdles to creating the sort of radical change that is needed in the U.S.

As Dr. Sachin Jain wrote: “The work of changing health systems is hard and complex and political and too fraught with consensus-driven decision making in areas where it is clear what needs to be done.”

I’m optimistic that it can be done. I’m also committed to improving the state of our current healthcare system in whatever way I can. I will not accept the status quo; I do not want to continue to be a cog in a broken wheel that tolerates unequal care and avoidable suffering.

I do not want to perpetuate a system that does not value a physician sitting at the bedside to listen. I solemnly pledged to dedicate my life to the service of humanity, to practice my profession with conscience and dignity, and to share my medical knowledge for the benefit of the patient and the advancement of healthcare. To me, that means trying to be the change I wish to see. I owe it to Mr. S — to all my patients. It is my moral obligation.

-By Rachna Goswami, M.D., M.P.H., resident physician, Baylor College of Medicine and MD Anderson Cancer Center

 

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