3 quotes from Dr. Don Berwick on moral dilemmas facing modern physicians

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Don Berwick, MD, lauded patient safety expert and former CMS administrator, described the current generation of physicians as "the most challenged by moral choices in perhaps a century" in an opinion piece published in JAMA Tuesday.

In the article, Dr. Berwick, one of the original architects of the Triple Aim, described a healthcare environment complicated by inequitable drug prices and a fragmented payment system. He also called on physicians to take the role of healer beyond the scope of the healthcare setting and speak out against social injustice.

Here are three quotes from the article.

1. On playing the role of hero: "[There's] the choice between being a hero and being a citizen. The white coat, stethoscope and prescription rights tempt some physicians into hero mode. Physicians have the power to look and act like we know what to do, even when we do not. We have the power to assert prerogatives denied to others: 'my schedule,' 'my OR time,' 'my air time,' 'my excellence.' But healthcare is an exercise in interdependency, not personal heroism. Physicians simply cannot do the right job alone. This produces a clash between the time-honored, romantic image of the great physician and the greater need for teamwork, generosity and deference."

2. On modern ethical challenges: "As a newly minted physician, I held unquestioned the belief that the organizations I worked in and for were, at their core, ethical; that healthcare institutions usually, if not always, put the interests of those they served ahead of their own. This may or may not have been true then, but it is not true now … For example, the drugs patients depend on are experiencing price increases that cannot withstand the scrutiny of public interest or moral compass. New biologics of undeniable value are being priced at levels that are not just like extortion — they areextortion, holding patients hostage.

3. On speaking out: "The work of a physician as healer cannot stop at the door of an office, the threshold of an operating room, or the front gate of a hospital … Professional silence in the face of social injustice is wrong. It is chilling to see the great institutions of healthcare, hospitals, physician groups, scientific bodies assume that the seat of bystander is available. That seat is gone. To try to avoid the political fray through silence is impossible, because silence is now political. Either engage, or assist the harm. There is no third choice."

To read the full article, click here.

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