What Happens When Doctors Become The Scapegoats Of A Broken System

Photograph by Leeloo Thefirst via Pexels

There is an unsettling trend I’ve become aware of. (And no, it’s not bleached eyebrows, but agreed, also unsettling). I notice it whenever I come across the term ‘doctor’ in an interview, or a news piece, or in one of the many books covering medicine-adjacent topics penned by writers who equate having read an article or two with in-depth knowledge of the medical system. 

It’s the tendency to blame and shame doctors for every real or perceived wrong in the current healthcare landscape.

I’m unembarrassed to admit that I’m proud of my ‘MD’ title. For me, on the inside of the system looking out, it stands for the endless hours of perseverance and hard work put in to make it through medical school and subsequent training, the many patients seen and treated no matter how challenging the circumstances, the many nights and weekends and holidays sacrificed, the years of cumulative sleep deficit acquired.

But for the outside world, it seems, doctors have progressively become the scapegoats of an ailing healthcare system. The tally of our perceived transgressions is long: we lack empathy; we can’t be bothered to take the time to listen; we’re overpaid; our clinical decisions are profit-driven; our knowledge is outdated, prejudiced, or just plain false; we’re pawns of the pharmaceutical industry- the list goes on.

It’s all too easy to blame physicians for everything that is wrong with healthcare today. We are the most visible, the top of the medical food chain, it would appear.

Except, we aren’t. There is so much missing in these one-sided conversations. So today, I’d like to introduce a bit of a counternarrative, not only because the prevailing one is wrong, but also because it’s harmful.

To anyone paying attention, it’s becoming more and more evident that, worldwide, healthcare systems are crumbling. The situation is reminiscent of climate change in that it’s been a long time in the making and has been largely underrecognized despite many concerned voices sounding the alarm for more than a decade. And like climate change, we have reached a tipping point, where the effects of this process are rapidly taking up speed.

In Germany, there is a critical lack of pediatric beds. We regularly face shortages of basic medications that force us to use less suitable alternatives to treat common illnesses such as strep throat or pneumonia. Parents frequently find themselves unable to get hold of pediatric formulations of ibuprofen or acetaminophen to treat their children’s fever and pain.

In the United States, pediatric departments are shutting down because they aren’t profitable, and children acutely in need of care are being moved out of state simply to access an ICU bed for conditions such as asthma attacks and RSV.

In the United Kingdom, patients wait over a month to see their primary care physician for urgent medical issues and there are no longer enough experienced physicians available to train medical students and junior doctors as more and more doctors in hospitals and practices leave the utterly overwhelmed NHS.

And yet, while we as physicians do our best to compensate the deficits in a system we did not create, we find ourselves increasingly shouldering the blame for its shortcomings. The unfortunate reality is that decisions are being made at tables we have no seat at. They’re being made by politicians without a nuanced understanding of the underlying issues, whose objective is to make it to the next term rather than find sustainable solutions for a complex problem that will require unpopular measures to begin to fix it. They’re being made by MBA’s brought in by hospital administrations looking to cut costs in order to remain in the black.

In short, they’re being made by people who have never once had to sit at the bedside of a patient and explain to the family that there is no clinic spot to treat their daughter’s severe eating disorder, no psychiatric unit that can admit their suicidal teen, no inpatient capability within a hundred miles for their sick infant requiring oxygen, that a life-saving surgery will be postponed because there are currently no ICU beds available, that their five year old’s chemotherapy will have to be delayed because there is yet another nursing staff shortage.

Doctors do not set the prices for medications. We do not determine which procedures will be reimbursed by insurance. We do not control the resources we have to work with, be it the constantly shrinking physician-to-patient ratios or something as simple as a functional electronic medical record system. These decisions are made behind closed doors while we care for our patients.

But somehow, each time it becomes evident that the system isn’t working for patients, the finger is reflexively pointed at us. Rather than a healthcare system failing to meet society’s needs, the narrative becomes doctors simply failing their patients.

As a physician, I’m not meant to say this upsets me. It’s inconvenient and frankly unwelcome for me to have feelings. Doctors are generally expected to be empty vessels that receive the needs, wants, frustrations, and demands of our patients and their families without adding any of our own to the mix.

But, inconvenient as it is, I do have feelings.

I feel heartbroken by the disparity between what medicine- at its best- can be and what it is increasingly being turned into.

I feel furious at a system in which ever more productivity is squeezed from workers with ever fewer resources because somewhere along the way we decided that healthcare- a profoundly unprofitable business- must nevertheless turn a profit.

And I feel discouraged that, after pouring myself into providing the best care I can in spite of the many obstacles placed in my path, I find myself casually and thoughtlessly discredited on the basis of incorrect assumptions.

I, like many of my colleagues, struggle with the overwhelming challenge of how to soldier on and fight for my patients in a system that doesn’t have my back.

The numbers suggest a similar dynamic playing out all across the globe. I recently came across an ad by the WHO noting that by 2030, we will be missing 10 million health workers worldwide. In a profession that demands so much of us, in which passion is expected to replace fair wages and self-sacrifice in the default, more and more doctors are opting out of clinical work. Faced with the impossible question of how to provide the level of care that is needed, we are simply burning out.  

We burn out because the struggle to give our patients more than our resources allow is so draining. We burn out because we question the impact we can have in a system that leaves us with our hands tied. We burn out because we are expected to see 1000 patients a day only to serve as the emotional wastebasket for the understandable frustration this causes those in need of better care.

Burnout, it turns out, is not just driven by overwork and overwhelm. It’s also driven by an unmet need to feel seen, by a lack of respect and validation for the challenging work we do.

So, as we enter an era of ever dwindling ER physicians, subspecialists, and primary care providers, I’m asking you to remember this. Your doctors are human beings, fallible and flawed, as we humans are prone to be. But we are also fighting mightily for you. We are on your- our patient’s- side. And we’d love for you to be on ours, because the system isn’t just failing you, it’s failing us, too. For better or worse, we are on this sinking ship together.

We’re not asking a lot. You don’t have to bring flowers to your next annual checkup or name your first-born after us.

A simple ‘thank you’ will do.