On a January morning in 2007 in Washington, DC, a young man clambered out of a taxi and descended into a metro station. He proceeded to play six classical pieces on his violin with his violin case open in front of him. Collecting $32.17 for his efforts, he packed up and returned home after 45 minutes. By video account, 1,097 people passed by him, of which only seven stopped to listen. The violinist was Joshua Bell, perhaps the greatest concert violinist of our time. He played the most complex and compelling music ever written on a handcrafted 1713 Stradivarius violin valued at $3.5 million.
Culturally, the story of Joshua Bell reflects our inability to appreciate the classics. Socially, it comments on our preoccupation with ourselves. On a human level, it exemplifies the contextual circumstance that encumbers any valuation we make.
Hidden in Mr. Bell’s little known reflections about his experience is the most important takeaway. He recalled six terribly awkward moments, each following the conclusion of an immaculately played piece, when he was greeted by silence. Frustrated, he began to seek approval, looking for any head nod, any sidelong glance, any tip of the hat acknowledging his playing skill, but he was reduced to seeking the scant approval of strangers in a metro station.
We have become like Joshua Bell in the metro station. As physicians, we are an immensely talented group touching millions of lives in the most intimate way, yet we have been reduced to seeking banal approval from mere passersby, the majority having no idea what we do, the depth of our passion, the magnitude of our self-denial, the soaring heights of our skill or the traditions in which our profession steeps. And so we passively, furtively grasp at the smallest bone thrown our way, happy to consider “only a 5 percent pay cut,” excited that someone might be tacking a faux “SGR fix” on an otherwise obscure, insignificant spending bill, exuberant to again be the dingy cast about in the relative sea of fate.
Most tragically, we have failed to stand up for our patients. Attacked on multiple fronts, we have been passive. We have endured tirade after tirade hurled upon us, provoking only shy, quiescent, head down responses. Our collective life’s work is compared unfavorably to inferior European systems as though they in some way hold the answer. They do not.
Physicians must rise up, step to the fore, and lead this charge. Our guiding principles are simple, laser focused and entrenched in the highest principles of our noble profession. In order to do this, we must:
- Strive to deliver the best, most appropriate care possible – not the best care Washington tells us we can afford. Their job is to find ways to pay for the care, not cut the care. We can start with reducing administrative costs.
- Demand that all our citizens have access to that care. Nearly 17 percent of U.S. citizens were not covered by health insurance, according to 2010 Census data. Perhaps this is a number easily overcome if hospitals became “cost centers” consuming resources rather than “profit centers” holding themselves up as providers of care, those savings used to facilitate those without such resources today. Brick and mortar cures no one.
- Lead in the incentives realignment so that all are focused on quality, cost-efficient, appropriate care, consciously consolidating resources, reducing duplication and stopping the obvious “medical arms race.”
We need not stand on the sideline, accepting meager bits of platitude, thankful for bones thrown our way. Let us play the hard pieces, rise to our full potential and enrich our country for the good of all of us.