No anesthesia board examination is complete without encountering a “pushy surgeon” scenario.  It goes something like this.  ”Doctor, what are you going to do if the surgeon wants to proceed with the surgery before these critical lab results are back from the lab?”  The young anesthesiologist responds with something like, “I’ll just tell him that he needs to wait.”  The board examiner becomes more animated and plays the role of an unreasonable surgeon, trying time and again to get the young anesthesiologist to cave.  Threats to ruin his career and get him thrown out of his new job fly out of the examiner with an intensity that is very lifelike if the examiner is any good.   If the young anesthesiologist relents, he fails his boards.  

What is this all about?  This is about making sure that the anesthesiologist knows that his primary role is to provide a safe environment and act as a patient advocate. ”Do what I say, or you are finished in this hospital!” This is an intense test of the anesthesiologist’s committment to the concept of the patient-physician relationship. 

This fiercely independent, patient-first attitude present in many physicians trained in the past, was no mistake.  It was part of medical school and residency training. Patient advocacy has required physicians to be tough with all who would stand in the way of what they thought was in their patient’s best interest, whether it be a hospital administrator, an abusive insurance company or incompetent staff.   Independent physicians until recently have been the rule, rather than the exception.  Now that the deck is stacked against patients receiving what they need, this trait is more important than ever. 

Now I’m not saying that this fierce independence is absent in young physicians.  I’m just saying that medical schools don’t promote this like they used to.  True patient advocates are more difficult to deal with for hospitals that would hire or control them.  Independent physicians are not as amenable to becoming an employee of a hospital or clinic.  Independent physicians are much more likely to be labeled “trouble makers,” and subjected to sham peer review tribunals and licensure board hearings.  Rather than fight for patients and standards of care, physicians are more and more corralled into “go along and get along.” 

For the Unaffordable Care Act to work at all, independent physicians, those who will fight for their patients when necessary, must be stamped out.  Those left will indeed do what they are told, rather than do what is best for the patient when there is a conflict between these choices.  This is a tragedy that will not soon be remedied.  As a patient you must make absolutely sure that your doctor is working for you, not for someone else.  Avoiding physicians employed by hospitals is a start.  

G. Keith Smith, M.D.