Evolving Medical Practice
We live in an age where sickness and disease have been turned into corporate profit centers, where, too often, woefully short 10-15 minute patient-doctor visits are the rule, not the exception. In this medical business era – Reuters reports the U.S. healthcare sector remains a “Wall Street darling” – insurance companies tell physicians what diagnostic tests are allowed and what prescriptions can be prescribed, all without speaking to, or even examining, the patients. To many, the health of the bottom line seems more important than the health of John Q. Public.
Yet, this is also a time of startling medical innovation, where advances frequently bring about longer lives of good quality. Today, surgeons can reshape a faltering heart so it can more easily pump blood.
Orthopedic problems and developmental abnormalities, which used to force people into wheelchairs and/or lives of low quality, are overcome by doctors who are artisans, using replacement materials that seem the stuff of science fiction.
Oncologists today, with more than just toxic chemo in their cancer-fighting arsenal, often use immunotherapy, offering up fewer side effects, to boost the body’s natural defenses to fight its cancer.
The growth in available medical knowledge is so rapid that an article in the Journal of the American Medical Library Association argues that for a physician, to stay completely current just on primary care literature, would need to read approximately 6,000 articles a day.
With physicians the key players in treating medical problems – patient education has been enhanced by the explosion of medical news on the internet – it is important to understand what current and future doctors think about the state of organized medicine and where they believe its future lies. What DAVID magazine learned from a veteran surgeon, a medical student, and a doctor who recently finished post-graduate training, is that despite unhappiness with the business of medicine, their commitment to the caring/curing profession is unwavering.
Fifty-year-old Dr. Michael Scheidler, the son of a mailman and the youngest of eight children, is the chief of the UNLV School of Medicine Division of Pediatric Surgery. Thirteen years of medical school, residency, and fellowships were required for his area of expertise.
A family practitioner, working out of a modest Pittsburgh, PA home, turned Scheidler on to medicine: “I loved the way he helped everyone in the neighborhood. I wanted to be like him.”
Though a love for technology in the surgical arena lured Scheidler away from a career in primary care, the family practitioner’s empathy for his patients has always stuck with him. “His respect for his patients, I’ll never forget that.”
Scheidler has been in Southern Nevada for 15 years. The married, father of two was, until recently, one of only three pediatric surgeons in the Valley. “I was on-call for almost all of those 15 years; weekends, holidays...It really was getting to me. It was hard not to have time off. But I couldn’t see how I could leave so many kids without care. They’re so innocent. They just want to play. They look at you, want to know why they’re sick. They didn’t do anything wrong, but don’t feel good. It compels you to make them feel better.”
Now with two partners, Scheidler has been a central figure in building the University Medical Center’s pediatric robotic surgery program, which began in 2017. The program promises reduced risks of complication, improved recovery times, and shorter hospital stays. “Soon, wire thin instruments will be passed through a single, small incision in the umbilicus and, with the aid of a camera positioned through the abdomen, true scarless surgery will be possible,” he says. “Realistically, we are only a few years away from obtaining this goal.”
Scheidler sees healthcare corporations focused far too much on profits rather than improving medicine. “Since their inception, healthcare costs have soared with administrators raking in huge salaries,” he explains. “For example, a CEO of a healthcare system in a mid-level city back east made $9 million last year...the primary goal of these systems is to make money by using the disguise of providing healthcare.”
The surgeon doesn’t see the current healthcare system, with too little time spent on the doctor-patient relationship or on consultations between doctors who should be trying to find an accurate diagnosis, as sustainable. “In a few years, I believe there will be a backlash from patients who feel isolated in healthcare. Patients feel abandoned and lost in the shuffle,” he says, disappointed. “At that point, healthcare plans will then provide a concierge-like service to their patients, which simply entail the docs talking to one another once again and...even more with their patients.”
Thirty-four-year-old Dr. Joshua Goldman – a native Texan who did his undergraduate work at Stanford prior to medical school at Texas Tech University – recently joined the UNLV School of Medicine to teach and practice after completing a two-year integrated craniomaxillofacial and microsurgery fellowship in Michigan. Prior to the fellowship, he completed a six-year residency in plastic surgery at UNLV.
Soon to play a key role in a planned UNLV Medicine Gender Affirmation Surgery Program, Goldman sees the ever-expanding growth of technology as a double-edged sword. “When rapid innovation has a substantial, positive impact on your health and quality of life, who could blame us for wanting more?” he asks. “In my lifetime, we will make custom tissue implants for reconstruction. In the not-so-distant future, we will be able to custom-make ears for pediatric craniofacial patients, organs for cancer patients, limbs for wounded soldiers, and far beyond.”
Yet, Goldman cautions, not all new technology in medicine is entirely beneficial to patients or doctors. He argues the electronic health record (EHR), where a collection of patient health information is stored in a digital format to make information available instantly and securely to authorized users, has decreased the time doctors spend with patients:
“While in theory the EHR has many valuable potentials, in practice it has become an onerous portion of the ever-increasing non-clinical work performed by physicians. In 2016, the Annals of Internal Medicine published a journal article concluding that physicians were spending two hours on EHR and desk work for every hour they spent on clinical face-to-face time with patients,” he says. “The increase in non-clinical work has not been met with a reciprocal increase in clerical assistance to allow physicians to rebalance their time, reflecting an administrative goal more focused on the bottom line than the patient and physician experience. This evolution, away from direct patient interaction, has certainly led to a denigration of the physician-patient relationship...Patients put the highest level of trust in the intentions and the knowledge of their doctors. When they encounter averted eyes and the back of a computer screen while expressing ailments and profound concern, the obligation that trust entails is simply not met.”
Goldman is clear about what he believes makes a great physician:
“Once you have all the certification and experience that make a competent physician – these are a necessary foundation – what makes a great doctor is personality, compassion, drive, individuality, and a sincere desire to connect with, and care for, patients,” he explains. “It is a mixture of knowledge of, and adherence to, evidence-based medicine and dedication to patient centered care.” This means advocating for both patient and physician wellness. It means getting involved in professional societies and engagement in quality improvement, as well as giving back to the community and the world of medicine at large. It means “late nights studying for tomorrows, really knowing the people I work with, making the hospital and OR home, and going the extra mile to leave a place better than I found it. An innovative mindset in all of these pursuits is paramount. Driving the future of healthcare is just as important as its provision in the present.”
Twenty-three-year-old Danielle Arceo, a Las Vegas native who’s starting her second year in the new UNLV School of Medicine as a full scholarship student, was homeschooled – her stay-at-home mother was educated as an engineer and her father is an administrator with NV Energy. Well before she entered a pre-med program at Pensacola Christian College in Florida, the medical field fascinated the young woman, one of seven children in the Arceo family.
“Since the time I first started carrying a purse, I always carried a first aid kit with me because I wanted to be ‘prepared.’ The initial reason I chose to become a doctor was that I wanted to engage in international medical missions,” she says. “That’s something that is still a passion of mine, but I don’t know at the moment whether it looks like a long term or a short term type of pursuit. Besides, truly, there are people within my current community who don’t have access to solid healthcare, just like people in third-world countries don’t, so I wouldn’t necessarily need to leave the country to help people in that way.”
Arceo says she sees more reliance on technology, such as video conferencing, in the future, especially if the physician shortage continues. “Do I think that’s the best way for medicine to go? No, not really – a significant element of our health as people depends on human-human interaction. If we strip that away in the medical setting, aren’t we compromising efficacy for efficiency?”
The medical student says the economics of health care have created a situation where patients have “limited one-on-one time with their physicians” and high co-pays for their doctor visits. “I think the system we have now is frustrating for everyone.”
Still unsure what medical specialty she’ll study, Arceo is excited about the possibilities of using adult stem cells to regenerate lost tissue. “Burn victims and traumatic injury victims would have more hope of full recovery; ‘wear and tear’ injuries that now require artificial joint replacements could have a more amenable option; and ultimately, those who are recipients of transplants would have an option that wouldn’t require them to be on immunosuppressants for the rest of their lives.”
A born again Christian, Arceo says science and religion co-exist peacefully in her life.
“Clinically, science can tell me how the human body works and what happens when things go wrong. Religion, rather, tells me the bigger purpose behind everything. Why are we here? What is the meaning of life?”
Dr. Michael Scheidler, UNLV School of Medicine, Chief of Pediatric Surgery.
Dr. Joshua Goldman, UNLV School of Medicine, Professor of Reconstructive Plastic Surgery.
Second year UNLV School of Medicine student, Danielle Arceo.