h u m a n i s m
D E V E L O P S K I L L S
INTRODUCTION
“Even in this era of health care as a business, with increasing pressure to contain costs, the secret of being a good doctor clearly still lies in what we do, feel and communicate at the bedside. To ensure that the next generation of physicians is equipped to give patients what they need, we must nurture their humanism and empathy — and redouble our efforts to preserve physicians’ ability to truly care for patients and their families as we bear witness to the inevitable cycle of birth, life, illness, and death. ” (34)
Hasan Bazari, M. D. ( 1954 – )
It would be unfortunate if the ability of medical school to attract the best students was impaired by their applicants’ perception of the current turmoil existing within our nation’s healthcare. One view of this turmoil might point to 1) the highly variable adversities affecting the equitable availability of Primary Healthcare for each citizen, 2) the financial instability of the reimbursement systems that predominantly impair the ecologic accessibility of health care for Basic Healthcare Needs, 3) the unpredictable stability of physician work environments and 4) the level of indebtedness for medical school post-graduates and its effect on their family and career choices.
Attracting a skilled and dedicated “front-line” for healthcare requires a professional work environment that is stable, innovative and supportive of Career Achievement Planning for each Primary Physician and their associated Healthcare Team. One possible view of this scenario is for NATIONAL HEALTH to consider an indirect responsibility to facilitate professional renewal strategies from within each of the medical school, educational communities. Specifically, the future functions of a Primary Physician will require an enhanced knowledge base and skill set related to the depth and breadth of uncertainty characterizing the human dignity underlying a person’s Basic Healthcare Needs. This will require a substantial shift in the ability of medical schools to model these functions from within their own institutional traditions.
In effect, a Primary Physician of 2017 should represent a substantially different “job” than the entrepreneurial physician of 1969. And yet, unchanged, there will still be a need to preserve and “nurture” the essential attributes of the truly caring physician. I thank Hasan Bazari, M.D. for his “Becoming a Physician” essay Gratitude, Memories and Meaning in Medicine. (34) I have reproduced a single paragraph from his essay to open this Global Task for NATIONAL HEALTH.
IMMIGRATION
Currently, the total number of practicing physicians is substantially dependent on immigration. There are many instances of especially talented physicians who have come to the United States and contributed greatly to the quality of research and healthcare in the United States. However, to what level should our nation encourage the immigration of these professional assets from other countries as a means to support our own needs to offer health care? Is it possible that neither our nation’s healthcare nor our nation’s foreign policy benefits from the uncontrolled international immigration of physicians to our nation’s healthcare industry? To the extent that the healthcare industry itself manages the equitable availability of vital physician skills including the level of physician immigration from other countries, our nation’s healthcare will avoid the risks of inefficiency related to critical shortages of vital physician services, especially for Primary Healthcare.
PROFESSIONAL RESOURCES
There is no current effort to achieve a national consensus regarding the education and work-environment requirements for our nation’s most important, healthcare asset: its physicians. A slowly evolving, national plan for ensuring the comprehensive education of and the institutional adaptation for our nation’s Primary Physician resources would contribute to the equitable availability of physician services necessary for its PRIMARY HEALTHCARE BENEFITS PLAN. A PRIMARY PHYSICIAN EDUCATION PLAN could be a unique opportunity for assuring that our nation’s healthcare is able to attract and train the physicians who will eventually 1) have a high commitment to altruism and excellence and 2) as a group, represent a comprehensive capacity to offer health care for Basic Healthcare Needs as well as the coordination of these Needs with any Complex Healthcare Needs required by any citizen. An Editorial written by David Goodman, M.D. has described the issues most succinctly. The Editorial appeared in the September 10, 2008 issue of JAMA (6).
REGULATORY ENHANCEMENT
One downside for the Initiative is that it represents yet another isolated regulatory process. It is a characteristic of any nation that the private sector may not uniformly provide for the Survival Commons of its citizens, especially their HEALTH. In highly closed societies, the private sector is largely “underground.” For our open society, the primary role for government and non-profit institutions is to perform those functions for our nation that the private sector is unable or unwilling to accomplish. One of these functions is regulatory control. Typically, regulatory control usually means setting standards or governmental use of financial resources as incentives, such as grants or loan guarantees.
The addition of NATIONAL HEALTH would represent another source of regulatory control. The additional regulatory control could be most clearly justified by its national perspective. This perspective is particularly important for medical schools, physician specialty board certification, hospital “Joint Commission” certification and their financial priorities. Specifically, a priority is necessary at each of these levels to ensure that enhanced Primary Healthcare is equitably available to and ecologically accessible by each citizen, community by community, as well as justly efficient and reliably effective. The concepts associated with the Design Principles for managing a common-pool resource should apply.
ELINOR OSTROM
Within the TRADITIONS Page (see Tab above), the INNOVATION Sub-Page presents a variety of concepts. These concepts have not found a prominent place within the world-wide arena of Knowledge for healthcare. Among these ideas, the conceptual basis for “Governing a Commons” is particularly absent. Elinor Ostrom formulated a general theory for understanding how a connected group of people can move beyond property rights to forming the collective action necessary for the preservation of a common-pool resource. The health spending for our nation’s healthcare is now exhausting our nation’s financial resources. In 2009, Professor Ostrom received a Nobel Prize for her research. Other than the isolated reference to an evolving “Tragedy of the Commons,” any connection to the nine books written or co-authored by Professor Ostrom beginning in 1990 does not currently appear within the knowledge arena of our nation’s healthcare reform.
See the MANAGING THE COMMONS Sub-Page for a broader discussion of the new strategy for healthcare reform based on Professor Ostrom’s Design Principles for Managing a Commons.
GATEKEEPER FOR NEW IDEAS
The essential focus for pursuing a new strategy for healthcare reform is its unjust efficiency and inequitable availability, especially for the health care of Basic Healthcare Needs. Beyond the immediacy of this crisis, the long-term stability of our nation’s healthcare will also be progressively assured by having a socially acknowledged and widely respected plan for the implementation of a new strategy for healthcare reform. The Paradigm for our nation’s healthcare must never be paralyzed again. Preserving this goal could be the most important safeguard, an institutional immunization, to be achieved by NATIONAL HEALTH. As noted on the a RATIONALE Sub-Page, a national commitment reminiscent of a “mission to the moon” will be necessary.
CONGRESSIONAL CHARTER PROVISIONS FOR THIS GLOBAL TASK
A. NATIONAL HEALTH will authorize an OPERATIONAL STATEMENT for preparing, announcing and distributing an Annual Report regarding its progress for achieving its GOALs and the affairs of it’s Board of Trustees, Regional Councils, District Coalitions and Community HEALTH Forums. This report will coincide with any Report to Congress required by its Congressional Charter.
[ COMMENT: The Annual Report could be a vehicle to initiate a pre-planned staged process for a broader national awareness regarding the importance of contributing issues, such as the character of each person’s Family or the importance of every Family’s Micro-Neighborhood Network. ]
B. The Board of Trustees in conjunction with the Regional Councils and their District Coalitions will establish a national dialogue for ensuring that there exists a uniform distribution in the equitable availability of Primary Physicians, community by community, and the related resources necessary for the Basic Healthcare Needs of each community’s citizens.
[ COMMENT: This commitment may be associated with the development and training of a CRISIS INTERVENTION Team ( CIT ) for each of the Tripartite Mega-Regions located in the Northeast, Southeast and Western collections of states. Each Mega-Region accounts for 1/3 of our nation’s citizens. The commitment of NATIONAL HEALTH to form its own CIT could initiate these Mega-Region efforts. Think Influenza Pandemic! ]
