By Robert Pearl, M.D.

This is the best of times to be a United States physician. But it also is among the most challenging.

My optimism about the professional lives of physicians today has ample basis in reality. The trust and respect patients feel for their personal physicians still runs extremely high. The number of medical school applicants continues to increase every year. The opportunities for physicians to improve the health of the American public are unparalleled. The practice of medicine remains among the most fulfilling of human endeavors.

Simply put, being a doctor is a rare privilege.

Even so, with every aspect of U.S. health care changing faster and more profoundly than ever before, day-to-day medical practice is becoming more frustrating and problematic. Physicians report working longer hours, spending a higher percentage of time on administrative and clerical chores, and feeling relentless pressure from multiple quarters, including insurance companies, regulators and the legal system. Increasingly, the business of medicine is interfering with the practice of medicine.

And physicians feel their voices are not being heard when it comes to the national policy debate about the future of health care in this country.

No wonder physician satisfaction across the country has declined to its lowest levels ever.

Over the course of three columns, I will examine this complex – and often contradictory – physician landscape. This series will aim to illuminate first what’s great about being a doctor today, next what’s most troublesome about it, and finally the fixes needed to ensure that the positive ultimately outweighs the negative.

The Latest Clinical Advances Border On The Miraculous

Physicians today take advantage of the latest advances in the science of medical practice, advances that over the past twenty years have enhanced what we can do for patients to a level, unimaginable in the past. As a result, on most days, physicians go home feeling the joy that comes from easing pain and suffering, averting a major medical problem and saving a life.

In the past, physicians watched as children with cystic fibrosis or congenital heart disease died before reaching adulthood. But today, we can save such children. Thanks to new surgical and medical management techniques, individuals with these – and many other – inherited life-threatening conditions are living longer and longer lives.

For decades cardiovascular disease was the number-one killer of Americans. That is changing today. With physicians understanding how to reduce the risks through medications and safely intervene at the first sign of trouble using safer procedures, we are progressively decreasing its associated morbidity and mortality.

Twenty five years ago, when physicians made a diagnosis of HIV, they knew it was a death sentence. But today, physicians can provide effective treatment, making the prognosis for individuals living with HIV/AIDS similar to patients with most other chronic illnesses. The result is the potential to live long, fulfilling lives.

Previously, surgeons kept patients in the hospital for as long as a week after a total joint replacement. Today most patients walk on the day of surgery and leave the hospital the next day. And using new technology, we can replace heart valves without having to open the chest, and treat many gynecological problems that previously required a hysterectomy with an office procedure that preserves the uterus.

In clinical practice, we still see complications, of course, and when they occur, they weigh heavily on us as physicians. But thanks to advances in technology and surgical technique, the frequency of those complications has decreased. As an example, we’ve reduced death after heart surgery to the low single digits. And for a growing number of patients, we’re minimizing the damage to the brain following a stroke.

Even with the best treatment patients still die. Certain cancers resist treatment and spread. Hearts whose muscle has weakened too much fail to respond to therapy. That’s just part of medical practice, and will always be a painful aspect of caring for patients. But compared even to 10 or 20 years ago, physicians today can offer their patients infinitely more therapeutic options, with dramatically better results.

The Information Now Available At Our Fingertips

A growing number of physicians have immediate access to the clinical information they need to provide the best medical care to patients. For many, particularly those in integrated care delivery systems and communities with robust Health Information Exchanges, the comprehensive electronic health record (EHR) has been a game changer for the better.

To understand why, imagine you are a physician in the emergency department seeing a man with mild chest pain. He tells you that two weeks earlier, his primary care physician performed a routine electrocardiogram (EKG) in his office. You order a new EKG, which you determine to be abnormal. If you can access the old EKG through a common EHR, the diagnosis is relatively straightforward. If in comparing the two, this new EKG demonstrates the same tracing pattern he exhibited two weeks earlier, the patient most likely is not having a heart attack. But if the new tracing is significantly different, you need to consider immediate intervention.

Of course, the diagnosis of a heart attack can be made without access to old tracing, but when you have this information, the chances of error are much lower. And increasing your chances of making the proper diagnosis adds greatly to your professional satisfaction.

Information technology provides the same type of information about medications, and confers the same types of benefits for patients and professional satisfaction for physicians. Previously, a physician could rely only on the patient’s memory. And often, all the patient could remember was that he took “a round white pill,” either two or three times a day.

But today, when a physician has access to a comprehensive EHR, she can obtain information which includes the medications prescribed by all of the physicians caring for the patient, and often, whether the prescriptions were filled at a pharmacy. Knowing rather than guessing makes clinical practice easier for the physician and safer for the patient.

Previously, physicians couldn’t be sure which preventive services colleagues had ordered or performed for a given patient, and whether the time had come to repeat them. Physicians don’t have the time to call five or six doctors’ offices to obtain the information. . Having that data at their fingertips allows them to do the right thing for the patient, without delaying care for the next patient who is waiting to see them.

And in the future, the advantages of modern technology will grow as physicians increase the use of genomic information and “big data analytics” in their practices.

The Personal Satisfaction That Comes From Helping Others

Providing health care is highly personal. People who are sick feel vulnerable and scared. And when physicians need to communicate a terrible diagnosis or that no matter what is done, death is inevitable, they are required to do so with great empathy and compassion. The patient – physician relationship dates back 5,000 years and is one of the most personal and fulfilling relationships. It is built on trust and mutual respect, and serves as a powerful force for healing. For the physician, it brings fulfillment and personal satisfaction well beyond earning a living, and is foundational for why they chose the medical practice as their profession.

As Abraham Verghese, the author of the novel Cutting for Stone, has described, there is a magic that happens when as a physician you take a history, perform a physical examination, render a diagnosis and complete a treatment plan. And this magic is as common and important today, as at any time in the past.

And some of us have the added privilege to teach the next generation of doctors. Their enthusiasm and eagerness to practice medicine are contagious.

If you ever doubt the mission driven spirit of physicians, just talk to those doctors who volunteer to travel the globe to provide medical care to those in desperate need in underserved locales. Or speak with physicians who volunteer, pro bono, to serve low-income, high-risk populations in clinics in your community.

As I look back at my own career, from training as a surgeon, to teaching residents and performing surgery for children with birth defects, to volunteering to provide care in a dozen underserved countries of the world, I can’t imagine having chosen a more fulfilling and meaningful profession. Being a doctor is a high calling.

But for all of the wonderful aspect of being a physician, the practice of medicine increasingly has become more frustrating.

My next two columns will look at why this has happened and, most important, what can be done about it.