My Role in Health Care's Existential Crisis

Contemplating retirement after 38 years as a family physician has, for me, been an uncomfortably revealing process. I can't help but remember the few patient-care regrets that still upset me after all these years, and I find myself wishing I could go back in time; do things differently; conjure up better outcomes. I can't, of course, but those memories of individual patients eventually led me to consider my entire practice life, the legacy I might leave, and my role in a health care system that has changed so dramatically over the course of my career.Far too late, I have realized that while I was singularly focused on "taking care of patients," I neglected an even greater responsibility: to advocate for myself and my patients and push back against an endless series of misguided policy decisions that have adversely affected the health and well-being of my patients and made my job so much more difficult and stressful.American health care is experiencing an existential crisis, and I regret that it has happened "on my watch." By not speaking up as a physician, I enabled others to speak for me, others with far less knowledge, understanding, or commitment to patient care. I regret that most of all.In this article I try to come to grips with why I was mostly silent, and I share what I am trying to do now at the end of my career to effect change and find my voice. Better late than never, I am speaking up for my colleagues and patients. Now, more than ever, I hope that we physicians will insist on being heard.