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Why I didn’t support the nomination of Vivek Murthy, but wish him all the very best

Last week the new Surgeon General of the United States, Vivek Murthy, was officially sworn in by Vice President Joe Biden. Congratulations to him, it’s quite an achievement at the relatively young age of 37. Nobody can doubt the hard work, intelligence and passion that must have gone into reaching such a height. His nomination was first put forward at the end of 2013 and he faced something of an uphill political battle until he was officially confirmed over a year later. Some of the controversy raged over his supposed advocacy for gun control, while others simply thought he was too inexperienced for the job. Let’s step back for a moment and look at his stellar educational credentials. He went to college at Harvard and has a combined MD/MBA degree from Yale. He completed his residency training and later practiced medicine at Brigham and Women’s Hospital in Boston, one of the nation’s top university academic centers. Along the way, he was commendably involved in organizations that helped with health education in the Third World. But the thing that really made a name for himself were his organizing skills as the founder of Doctors for America, a political organization that advocated for President Obama and healthcare reform. This was probably the single biggest achievement that led to him becoming known on the national political stage and eventually becoming the nominee for Surgeon General.

During Vivek Murthy’s long confirmation process, I received many emails and social media shares in support of him, citing a number of reasons why everyone should back him. These ranged from simply being because he was President Obama’s choice, to other more personal reasons why I should support him. One of the reasons was because he was a hospital medicine physician—the same specialty that I am. Okay, that’s great for our specialty, but I found this reason alone a little bit flimsy considering the prestige and importance of the position. Another reason, which I found the most irritating (bordering on insulting) was because he is of Indian origin—just like myself. I’m not even going to get into why race alone should never be a reason for supporting anyone, and although I’m very proud of my background and culture, that’s not enough to make me ever support someone without fully understanding what they’re really all about as a person, nor is it the way that I’ve been brought up to think.

No, my sole reason for not being supportive of his nomination—which I received some flack for when I said this amongst friends and colleagues—is that I simply thought he had not achieved enough within the medical field itself. In my opinion a Surgeon General should have practiced medicine for a considerable amount of time before being a viable candidate. They should not only have proven themselves to truly be a top doctor and role model, but should have worked long enough in the healthcare system to profoundly understand it. Being primarily a political advocate is not enough. Same goes for any other similar position where you should be at the top of your profession, whether it’s a Supreme Court nominee or Attorney General. There’s nothing wrong with doctors being politically active and supporting a presidential nominee, but does that alone necessarily qualify someone for a position that is widely seen as the nation’s top doctor? Over the years since the post was first established in 1871, it has been occupied by a number of very accomplished physicians. Dr Walter Wyman, who served for 20 years from 1891 to 1911, worked in a city hospital and then private practice before getting involved in cutting-edge hygiene and bacteriological research. Dr Luther Terry, best known for his warnings about the health dangers of tobacco, was a notable pathologist and teacher before he was appointed by John F Kennedy. Dr Charles Everett Koop, appointed by Ronald Reagan, was a highly accomplished pediatric surgeon at the Children’s Hospital in Philadelphia before his tenure. In his time overseeing the surgical department, he helped establish America’s first neonatal surgical intensive care unit.

This is nothing personal against Vivek Murthy. I’m sure if I ever had the honor of meeting him, from what I’ve seen of his interviews and discussions, he’s a thoughtful, highly intelligent and sincere individual with good intentions. His personal story, as the child of immigrants who went through a great deal to get to the shores of the United States, is admirable and represents the fulfillment of the American Dream. And now he’s the new Surgeon General. As with any job, it’s what you do when you get there and not how you got there that counts. That’s what people will remember. And with that, I wish him all the luck in the world and hope he succeeds.

Suneel Dhand is a physician, author, speaker and healthcare consultant. He has experience in a number of different healthcare environments, having practiced medicine up and down the East coast and also internationally. Suneel is the Founder & Director of MangoWell, an organization and consulting service that helps hospitals and healthcare professionals improve the quality of hospital care, deliver a better patient experience, and optimize healthcare information technology.

Also visit Suneel at his website: www.suneeldhand.com

3 things every physician should tell themselves after a bad day at the office

Being a doctor is one of the most emotionally and physically demanding professions out there. The healthcare landscape may have changed a lot over the last decade, but the basic unavoidable grueling nature of medical practice has been the same for time immemorial. I remember reading a careers advice book when I was a teenager telling me just that; namely that being a doctor was “the most challenging of jobs”, and to be absolutely sure before walking the career path. All this time later, I realize how true those words were—and then some.

Whether it’s an unsuccessful outcome, difficult patient, administrative clash, or excessive workload; there are plenty of reasons to come home feeling exhausted and jaded. When this next happens, here are 3 things to tell yourself to perk yourself up a bit:

1. Life can be a whole lot worse

Thought you had a bad day? At least you are the doctor and not the patient. It may sound very rudimentary, but how easy is it to take for granted that you are the one in the white coat and others around you are suffering. One day it could well be you. In the meantime, cherish the fact that you are the healthy one (hopefully). Because nothing comes before good health and the ability to live life free of serious illness or disability.

2. High pay

I can only speak as someone who has had experience working in the USA and UK, but almost all physicians in both countries comfortably find themselves in the top 5 percent or more of the country in terms of income. Got that? Over 95% of citizens likely earn less than you. This holds true even after physicians’ not insignificant debt burden per month. Most people couldn’t dream of earning as much as doctors, neither do most people have the talent, intelligence and persistence to become one. You also live in America, which by itself puts you in the top percentile of the world. The United Nations estimates that 2.7 billion, almost 50% of the world’s population, live on less than $2 a day. It’s only by the grace of God or sheer luck (depending on what you believe) that you are not one of them.

3. Meaningful job

You don’t mop floors and don’t carry bricks across construction sites. Physicians may not always realize it during the hustle and bustle of a typical day, but you are held in high respect by the vast majority of your patients and also society at large. Telling anyone you are a doctor is something you should be proud of accomplishing. The amount of trust placed in your decisions is humbling. A lot of any professional’s respect is self-made, and if you really feel disrespected and unvalued at every turn—perhaps it may be time for some self-reflection as well? No physician should ever go home feeling like they haven’t done something important that has made a positive difference in someone’s life, typically at a time when that person is at their lowest point in life too.

Being a physician has tremendous rewards and also challenges. Tell yourself the above 3 whenever you are driving home frustrated. That doesn’t mean that you shouldn’t try to make things better or look for other things that fulfill you (nobody should ever stick with something they really don’t like)—but it does mean that you should keep those daily frustrations in perspective.

Suneel Dhand is a physician, author, speaker and healthcare consultant. He has experience in a number of different healthcare environments, having practiced medicine up and down the East coast and also internationally. Suneel is the Founder & Director of MangoWell, an organization and consulting service that helps hospitals and healthcare professionals improve the quality of hospital care, deliver a better patient experience, and optimize healthcare information technology.

Also visit Suneel at his website: www.suneeldhand.com

What doctors can learn from Uber drivers

A couple of months ago I finally joined the swelling ranks of Uber customers. Several friends had been trying to persuade me for some time to start using the service, but me being generally skeptical of new technology (what they call a “late adopter”), it took an extreme situation to get me to finally download the App. It was a freezing February evening and I was just getting home from work. Boston had experienced yet another severe snowstorm and there was a parking ban in effect. I drove around my neighborhood for some time, and there was absolutely nowhere to park. Frustrated, I took the decision to drive to a nearby garage and leave my car there for the next few days. I was sick of shoveling and clearing the snow off my car every morning, and with even more snow forecast, I decided that I would just use alternative transportation to get to and from hospital until the weather eased a little. So when I got home that night I did it: I made the decision to download Uber onto my iPhone. The following morning I used their screen interface and tracking system (which is slick, user-friendly and overall excellent) to hail my first Uber driver. They were outside my house in a matter of minutes, and dutifully drove me to the hospital in good time. I continued to use Uber for the rest of that week, until finally it was okay to get my car back. I was absolutely blown away by the service I got and since that time have been using them regularly—in at least a couple of different US cities.

More than the actual service, I have also been highly impressed with the Uber drivers themselves. Perhaps I am lucky or perhaps Boston attracts a different category of drivers, but I’ve met some really interesting people on my car journeys. Some of them have other full-time jobs (including in healthcare), some are still in school, and some are budding entrepreneurs who were starting up side businesses. I’ve been driven by men and women of all ages and backgrounds. No disrespect to regular taxi drivers, but the conversations I’ve had with Uber drivers in the last two months have been far more interesting than the ones I’ve had with regular cab drivers over the last several years. They’ve told me stories about what brought them to driving with Uber and how the process works to get registered, have background checks, and then determine their own work schedule. There’s also another common theme that emerges: Uber drivers absolutely love what they do. They enjoy the fact that they work on their own terms and are free to earn as much or as little as they like. They are independent contractors and feel in control of their schedule. Most of all I’ve heard they really enjoy being their own boss and not being told what to do and when to do it. Lots of them work very long hours, averaging 12 hours a day of driving, but were choosing to do so. Nearly all the drivers were educated (and heck, some of the cars I’ve been transported in have been high-end luxury models) and had high hopes and aspirations. One thing they would never do: be a regular employed taxi driver.

So how does this tie into doctors and healthcare? Well, the last decade has seen relentless consolidation and amalgamation, with the majority of physicians moving towards a standard “employee” model. The days of the small group practice and solo-practitioner seem numbered. With any perceived improvement in work-life balance or employee benefits that this may bring, also comes a hefty price to pay. Employees will always have less control over their work life. Many things will be dictated from above about what they must and mustn’t do. These are the unavoidable parts of being an employee that suck. But that’s the trade off.

The happiest physicians I still see are the ones who are in their own small practice and have not yet been taken over by a larger group. They may work harder (like any entrepreneur) but they wouldn’t have it any other way. What’s more, their patients seem to be happier and more satisfied too (a bit like me with the Uber drivers?). Yet the reality is that consolidation is the direction of healthcare whether we like it or not.

The battles that Uber is fighting with entrenched organizations such as taxi firms are well publicized in the media. One Uber driver told me that there’s another big legal battle stating that Uber should ditch the private contractor model to make all Uber drivers “employees” of the company with a salary. When I asked him what he thought of this, his response was a resounding “Hell No!” and he said he would find something else to do if this ever happened. While doctors may be losing the battle for autonomy, I hope that the enterprising and fiercely independent Uber drivers are smart enough not to.
Suneel Dhand is a physician, author, speaker and healthcare consultant. He has experience in a number of different healthcare environments, having practiced medicine up and down the East coast and also internationally. Suneel is the Founder & Director of MangoWell, an organization and consulting service that helps hospitals and healthcare professionals improve the quality of hospital care, deliver a better patient experience, and optimize healthcare information technology.

Also visit Suneel at his website: www.suneeldhand.com

My day on Capitol Hill advocating for hospital medicine

Last week I was honored to spend a day on Capitol Hill as part of an advocacy event with the Society of Hospital Medicine. The organization, which I am proud to be a part of, held their annual meeting in Washington DC. The event involved a group of hospital physicians going to Capitol Hill to meet our congressional representatives—both in the House and Senate—to discuss the issues and upcoming Bills that are most pertinent to us and our patients. Our three main talking points were; Sustainable Growth Rate repeal, the Medicare 3-day inpatient rule for skilled nursing facility care, and better end-of-life care.

We were split up into groups according to our home states (myself and another physician representing Massachusetts) and then bussed out from our Convention Center to the Capitol. Three meetings were scheduled for each state’s hospital physicians—one on the House side and two on the Senate. It was a very insightful day and highly interesting to see how democracy works close up (most people probably don’t realize that government in this nation is so open, and they are always welcome to schedule appointments with their elective representatives).

I actually went to the same event a couple of years ago, but this time we were much further into the legislative cycle. It was also fascinating to observe the different receptions given to hospital physicians according to which state they came from. Those of us who came from the more liberal-leaning states generally had a much smoother time with our discussion points and making sure our representatives were fully on board with the Bills. The physicians who met with the more conservatively inclined political offices tended to be quizzed much more on the cost breakdown and where the money would come from to fund the Bills (and who could argue that these are bad questions?). In fact, we were briefed beforehand that this would happen and to be mindful of who we were talking to and where on the political spectrum they fell. For example, with the 3-day rule, were we going to frame our discussion around improving access or controlling costs? Or better still, could we do both? All of us were going to the Hill with very noble intentions, but it would have been naïve to think it was all about what sounded good to us. All new policies have some very real world implications that provoke strong sentiments according to political philosophy.

However, regardless of whether one is liberally or conservatively minded, my day on Capitol Hill also reinforced a much bigger point. Politics can seem frustrating and infuriating from the outside. The differences can seem petty. But when you’re inside, you realize that it’s all too easy to sit back, complain, and be the Monday morning quarterback. There’s a famous saying that decisions are made by those who show up. In a democracy, it’s all about getting your voice heard and arguing your point no matter what your political affiliation. Every citizen has a chance to do that—and a civic duty if you feel strongly about something.

Suneel Dhand is a physician, author, speaker and healthcare consultant. He has experience in a number of different healthcare environments, having practiced medicine up and down the East coast and also internationally. Suneel is the Founder & Director of MangoWell, an organization and consulting service that helps hospitals and healthcare professionals improve the quality of hospital care, deliver a better patient experience, and optimize healthcare information technology.

Also visit Suneel at his website: www.suneeldhand.com