Doing a little self-reflection, I’ve found myself having more and more libertarian thoughts running through my head–usually of a “personal responsibility” or “individual behavior” nature, and I’m trying to understand why they’re popping up. Here’s the theory; it may explain why many physicians are somewhat libertarian in nature as well:
Physicians want to help people. In practice, I think, much of one’s ability to help is limited by patient adherence: we can only give suggestions to patients. They can choose to take the medicines we prescribe, to get the additional tests we request. Many times I think we assume a patient doesn’t follow a care plan because of some intrinsic personality characteristic–when often it’s a problem with understanding or other situation that prevents perfect adherence. Many times things totally unrelated to medicine influence a patient’s ability to get care. If they don’t have transportation, how can they get to their doctor? If they don’t have money, how can they pay for medications–or even co-pays? If they don’t live in a good neighborhood, how can they be expected to eat fruits and vegetables, or get exercise if there are no safe places to work out, or no gyms in the area? If they lack the education and we don’t talk at a level they understand, how can we expect them to participate in their care? If we don’t have a translator, pantomiming and charades only goes so far.
So I think a lot of the time physicians feel like their work is in vein. The realm in which we try to help is that of the individual. So if an individual doesn’t follow-up appropriately, or doesn’t take their medications, we assume it’s an individual problem. We’re so intent on seeing that one tree that we forget that it exists in a forest. I think if more physicians took this approach (or maybe if more medical students were taught with this approach in mind), we might have more physicians advocating for institutional, society-wide changes in the foods our patients eat, the ads they see on television, and the lifestyles that they live.