The Privilege of Service

Three Green apples on turquoise background. Healthy food three pillars concept.

The way we take care of patients is changing very quickly. Physicians and the rest of the health care system are being forced to learn new ways to do their work. Although the federal government’s approach to health care varies with the policies of the particular administration that happens to be in charge, the overall trend is towards more regulations that are said to improve quality and decrease the government’s financial outlays. The same is true of private insurance companies. Many other regulatory bodies and government agencies pile on more rules, policies, and procedures. The net result for doctors is more red tape, pressure to see more patients, and lower reimbursement for our efforts.

Many physicians have grown increasingly disenchanted with this system. Burnout has mushroomed from an obscure topic to a major concern in our profession.Instead of giving in to anger and frustration, now is precisely the right time to step back and reassess. We need to remind ourselves of the tremendous privilege we enjoy by practicing neurosurgery in this country. Lost in the hassles of modern medical practice is the fact that we serve our patients in amazing ways: restoring function, relieving pain, saving lives. We each have a front-row seat for witnessing and chronicling the wonders of the nervous system.

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In the years ahead, service will become increasingly important for our specialty. That’s why The Privilege of Service was chosen as the theme for the 2018 annual meeting of the AANS.

The traditional mission of a medical school is commonly broken down into three areas: research, education and patient care. Someone who excels in all three of these areas is described as a “triple threat.” The future will require that we focus on three additional areas, which are types of service that apply to all neurosurgeons, not only those working at medical schools. These three areas can be described as the three As: administration, advocacy and altruism.

Why administration? Many neurosurgeons run as fast as they can from such roles, preferring the fast pace and immediate gratification of clinical neurosurgery to the slower rhythm of the administrative world. But the things that frustrate us in our work are not related to our patients. They’re related to problems that only administrators can fix: inefficient utilization of operating rooms, disorganized clinics, obsolete equipment, inadequate numbers of nurses, ineffective electronic health records, and so on. We can’t fix those if we’re always in the OR. If we ignore our administrative obligations, or skip important meetings, or refuse to work within the system, we’re only perpetuating our problems. It’s much better to be a decider, or at least to have a voice when the decisions are being made.

The word “advocacy” conjures up images of political lobbying. That work is important, but it’s only one type of advocacy. The government—and therefore the public—pays for an ever-growing share of medical care in this country. People have a right to know how the health care system really functions, which is very different than how it’s usually shown in movies and the media. We also need to advocate for our profession and our specialty. Because we depend upon hospitals for the sophisticated technology we need to do our work, we would be wise to partner with them and advocate for them as well. The same is true for medical schools and other academic facilities that engage in research and teaching, without which our specialty would flounder. Most important of all, we need to serve our patients by advocating for them and for their right to make informed decisions and be the ones who have the biggest say in their health care.

Altruism is at the very core of being a physician. When we take our oaths during graduation from medical school, we all pledge to serve our patients and to behave altruistically towards them. Somehow, as years of daily bureaucratic frustrations progressively erode these best of intentions and as graduation oaths fade from memory, some of our colleagues forget this most basic of promises. When a neurosurgeon places his or her own wants above those of patients, the results can be disastrous. We all suffer when this happens, most of all those patients whose physicians failed them.

Now more than ever, it’s important to remember that we are blessed with the privilege of serving our patients and our communities. This mindset allows us to take our service beyond the operating room, the clinic, or the emergency department. We can shape key administrative decisions, we can push ahead in new opportunities to advocate for our patients and our specialty, and we can renew our commitment to altruism and selflessness. It’s a privilege to be able to serve our patients in so many ways.

Editor’s Note: The Privilege of Service is both the theme of the upcoming AANS Annual meeting in New Orleans and of the current issue of the AANS Neurosurgeon. This issue contains fascinating stories about many remarkable neurosurgeons who exemplify the concept of altruism!



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