“Grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” I’m not usually one to quote religious text, but this excerpt from the Serenity Prayer resonates. Perhaps the most pointed and overwhelming challenge facing physicians today is the loss of control over our profession. The last three decades have seen dramatic erosion of the status, ownership, and independence of physicians.
The root cause is multifactorial to be sure, with influence from powerful special interests across multiple industries. Lawyers, insurers, hospitals, pharmaceutical companies, and government agencies have collectively spent billions of dollars influencing patient care. More importantly, they have used their influence to shift finite budgets and funding to interests other than physicians. Without a unified, profit-motivated voice, physicians are confronted with the “money vs medicine” dilemma. Most physicians, self-sacrificing by nature, choose patients over profit. The other special interests know this and take advantage of our lack of organization and altruistic spirit. And physicians are left holding the bag in the end.
Individually, this can leave us feeling deflated, demoralized, and downright angry. While other special interests trample the patient as they lobby through Washington, we watch helplessly even as our own small piece of the pie is eaten. The problem is that we are the closest relationship that most patients have with healthcare. They certainly feel distant from and under-represented by hospitals, insurance companies, pharmaceutical companies, and the government! We own these personal relationships more intimately and directly than any of the special interests do. In fact, we are in service to these relationships by the oath of our profession and the commitment to our discipline. Thus, advocating for our own interests often puts us in direct conflict with our patient relationships.
Together, this combination of guilt and powerlessness contribute to the learned helplessness that many of us feel in our chosen profession.
Back to the Serenity Prayer, then:
- “Grant me the ability to accept the things I cannot change” ‒ Regrettably, I am resolved to the fact that we have almost no influence over the funding of healthcare nor the division of that funding amongst the stakeholders. We are at the mercy of a much larger system, and without the ability to truly organize and leverage against the special interests, we stand no chance in the current climate. Acceptance relieves the burden of anger and guilt.
- “Courage to change the things I can” – Despite my rather bleak assessment, we do have opportunity for change. Our power lies firmly in our individual relationships with patients and colleagues, and even our adversaries. Nurturing and developing those relationships builds influence—which we can use to make a difference for our patients and our profession.
- “And wisdom to know the difference” – Perhaps the most difficult to achieve, wisdom requires self-awareness, humility, and accountability, traits many physicians struggle with. Our profession demands “knowledge” and our patients expect the same. When knowledge is the bar, however, we can fall prey to right-vs-wrong assessments, leaving us vulnerable to paralyzing judgments. Wisdom, unlike knowledge, thrives on flexibility and a willingness to take chances. Chances that may lead to failure.
The overarching concept here is rooted in most spiritual and religious teachings: In order to gain control, you have to be willing to give up control. A powerful message for a profession that can shun “faith” as unscientific. But it might just be what the doctor ordered!