What's the biggest barrier to practicing medicine today? David Chang, MD, PhD, a neurosurgeon at Midwest Spine & Brain Institute in the Minneapolis area, answered this along with nine other questions that MedPage Today is asking thought leaders in medicine.
After receiving his doctoral degrees from Johns Hopkins University School of Medicine, Chang completed his neurosurgical residency at Mount Sinai Hospital, and his neurosurgical fellowship at the National Institute of Neurological Disorders and Stroke.
1.What's the biggest barrier to your practicing medicine?
Insurance companies/ managed care companies who are not willing to approve of indicated treatments.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds or tests, etc.) and how did you respond?
A young software engineer from Pakistan who began developing severe back pain. He had contracted TB (tuberculosis) in his home country, and it had spread to his spine, causing Pott's disease with partial destruction of both L5 and S1 vertebral bodies. He didn't have insurance because as a young 30 something man, he never thought he would get sick.
He saw several neurosurgeons, including his own uncle who was a board certified neurosurgeon. Everyone turned him down because of lack of insurance.
After some prayer, I decided to take him on -- gratis. We got him admitted to a Catholic system hospital under a charity program, and did an anterior/ posterior lumbar fusion of L5-S1. I waived my physician fee. 6 months later his back pain resolved and he was able to ambulate independently.
3. What do you most often wish you could say to patients, but don't?
Please lose weight and stop smoking -- you can do more for yourself than a thousand doctors can!
4. If you could change or eliminate something about the healthcare system, what would it be?
All of the middle parties who insert themselves between physician and patient. That includes the insurance companies, managed care, business people, lawyers, etc.
5. What is the most important piece of advice for med students or doctors just starting out today?
Please be sure this is what you want to do, because it is a long, arduous road with many setbacks. It will require a lot of determination and persistence.
6. What is your "elevator" pitch to persuade someone to pursue a career in medicine?
Help save a life. Help ease someone's suffering. It has always been and will always remain a noble profession.
7. What is the most rewarding aspect of being a doctor?
Occasionally I will get a card thanking me for helping someone with their pain and suffering. I have kept every single one of those cards. They help remind me why I became a doctor.
8. What is the most memorable research published since you became a physician and why?
Goldman JM, Melo JV "Chronic myeloid leukemia – advances in biology and new approaches to treatment" in the New England Journal of Medicine in 2016.
Why: the creation of imatinib is the culmination of more than 50 years of scientific research, beginning with the description of the Philadelphia chromosome in 1960, the discovery of the c-abl proto-oncogene, it's constitutive activation by the BCR promoter, the discovery of tyrosine kinase inhibitors, the invention of imatinib through combinatorial chemistry/ high throughput screening. The entire body of work is breathtaking in totality.
The authors of the above review article summarize the entire body of work best: "An extraordinary series of discoveries about chronic myeloid leukemia (CML) has made this disease a model of the way in which bench and bedside research can unite and culminate in clinically important advances."
9. Do you have a favorite hospital-based TV show?
No.
10. What is your advice to other physicians on how to avoid burnout?
Spend time with your family, find a few favorite hobbies.