This week, i am spending my working hours editing orthopedic sport medicine videos, specifically rotator cuff repair surgery. I can see how people (and by people i mean me) can forget why the stature of the American physician has reached such heights in our culture. To see the work of a surgeon, before, after and (a view rarely seen) during a procedure focuses an issue i have noticed taking shape within the current debate to improve health care.

Surgeons are branded in the medical world with having egos that would make roman rulers gasp, but after watching five intense muscle skeletal surgeries, I can see why. Both the physical exertion to set bones and the gentle skill to tear and manipulate seemingly identical muscle structures demands superior training. And the lexicon. Oh the lexicon! I am editing about an hour of voice over where i understand every fourth word. The argument of certain surgeries being necessary aside,  the results speak for themselves. When these physicians work on aging bones and give a modicum of comfort to the elderly, or when a procedure allows an athlete to maintain noticeable levels of physical genius, one can appreciate why a person would feel the rush of omnipotence.

It is certainly not the case for all doctors to enjoy this level of ego heights, but it would be almost wrong not to feel some importance. See, regardless of the reason that a doctor chooses to persue medicine, whether it be money, fame, wealth, duty, passion or altruism it is always at the great costs of youth, leisure, freedom, sanity, and financial wellbeing. Becoming a doctor is a long (up to ten years post pre-med undergrad), expensive ($250k with interest) endeavor filled with tests (a major one annually for many fields throughout med school and residency). The glamerous life of the modern doctor includes 80 hour work weeks, with the best pay for residents in the lower 60′s. All of this is to gain access to helping people.

It demands a kind of fortitude that convinces the student that it is more fruitful to slog forward than it is to attempt to ever reverse track. I have heard many medical students declare that medical school breaks you so completely, it leaves most incapable from persuing other work. There are few people who can do it, who can withstand the daily grief, the complicated and confusing system, the sea of opposing interests that rarely recognizes their needs. They are essential cogs in a rube goldberg machine on high.

Qualify what I have said and will claim with my biases. I work for doctors. I live with and date a doctor. I have seen many friends go through the process. But these biases allow me notice how the debate over healthcare reform ignores the most important things that keep a doctor from fully achieving excellence. Those distractions include the ‘cover your ass’ mentality exacerbated by the unfair spectre of litigation. They include the astronomical insurance fees doctors pay to practice their craft, again worsened by the unfortunate moments when a patient, sometimes prodded, declares that a fullhearted attempt, was in fact an incompetent mistake.

They include debt. Mindboggingly massive amounts of debt. It’s like paying a quarter of a million dollars for chains. It limits the type of work that seems attractive. The salaries of the most needed types of doctors, general practitioners, is an inefficient way to tackle that debt. And even though the media makes it seem that every graduating med student is becoming a highly paid dermotologist, the truth is there are very limited opportunities for these types of lucrative positions.

So, it seems that plenty of people and organizations watch the watchers. Who then stands up for and is on the doctor’s side?

It’s not the AMA, whose effort for almost a century to retard health care reform is complicit in worsening the experience for its dues paying members. It’s no coincidence that less than half of doctors call themselves members.

It’s not the insurance companies, who seek higher premiums and lower reimbursements for harder procedures.

It’s not the US government. Obama’s speech a couple of weeks ago demonstrates that. Where was the serious talk of tuition forgiveness or tort reform? Democrats see universal health care as one of its five pillars, and has shown little sympathy for the reality that doctors face with broadening healthcare: an increase of customers face a stretched thin doctor corps. The republicans see no need to improve anything. Let the market decide how badly doctors are treated.

It’s not the increasingly adversarial patient, who at times can confuse the doctors need to emotionally disconnect as lack of empathy.

It’s not the trial lawyers, a politically powerful lobby which swells democrat ranks and coffers. If you ever want to see a doctor lose their professionalism, mention you are a trial lawyer.

Largely, the lonely status the American doctor feels right now is a bi-product of caring too much, of being a success, as great helpers and healers. A time sucking situation, it keeps them from even understanding how the system works and makes it even harder for them to help in efforts to improve it. Read this slate article on the issue. Cogs cannot self repair.

Notice the criticism leveled at doctors in the recent New Yorker that takes a look at the rising cost of health care in one Texas town. Doctors do too many tests. But why? Because they do not want to be sued. Because they have the technological ability. Because, above all else, they want to get it right. Seems like all these wants sound legitimate  to me. How will the new system recognize that the doctor is not the enemy here, and is mostly unprotected from such massive risk?

My fiends and I have had an epically long debate about how Scrubs can find itself still on the air, cancelled by NBC, brought to ABC and now being totally retooled as a med school show. They ask, who watches this unfunny, ridiculous portrayal of doctors? Answer? Doctors. No doubt annoying, it probably shows the most accurate portrayal in current media the process of becoming a doctor. Working all the time, desperation, failure, fighting with administrators, mingled with concerns over love and family and friends and expanding waistlines. Yes, scrubs, with dozens of procedural inaccuracies in each episode, is quite possibly the only fair portrayal of doctors on television. Chew on that.