Well, do YOU love everything about your job?!
Is it so surprising that I would have pet peeves and things I would change about mine?
I’ve been getting ready for vacation this last week and it seems like when you’re really busy with multiple tasks, little irritations tend to get under your skin. And BIG irritations become almost intolerable!
This week I’ve been reminded over and over of the 3 curses of modern medicine, and thought I would write about what I would change about medicine, if I could.
1. Government regulation
The government is intruding more and more into the daily practice of medicine. From the Meaningful Use fiasco to endless HEDIS audits to the Patient Centered Medical Home initiative, the federal government is insisting on more and more control of the daily practice of medicine. They also are beginning to insist on the power to decide which doctors provide good care and to pay them more on the basis of these metrics.
Why should patients care about these problems? As I wrote a few months ago, if the government decides how much to pay doctors based on their patients’ test results, doctors will begin to fire patients who refuse to (or who are unable to) get their numbers into the goal range.
The problem with government metrics determining how doctors are paid is that DOCTORS aren’t in control of their patients’ illness. PATIENTS are. The government doesn’t care that the doctor ordered the tests and recommended dietary change and regular exercise and weight loss and ophthalmology/podiatry/dental care. The government only cares that the tests didn’t get done and the meds didn’t get taken and the eye exam didn’t get done. So patients who don’t take their doctors’ advice (who are frustrating patients to take care of in the first place, see #3 below) will begin to be shown the door and told to find another doctor.
2. Administrative busywork
From documentation requirements for the above government initiatives (and others) to medication and test preauthorizations, doctors are having to spend more and more time on finding and jumping through government and insurance-company hoops. The only alternative to ME spending my time on the phone and filling out paperwork is hiring more staff to do it for me. (We not-so-privately think that’s part of the government’s plan to stimulate the economy and create jobs. Create more and more busywork to clutter up the practice of medicine so that doctors have to hire more staff to take care of it.)
3. Being a prescription-writing service
I have a handful of patients who refuse to listen to me. The only reason they come in is because they need a medication and for that, they need to see a doctor. They resent having to come in, abuse my staff, complain about everything, and force me to hold their prescription hostage until they either make a personal appearance or get their bloodwork done. They are exhausting! I have told more than one of them that I would be happy to forward their records to another doctor if they are so unhappy coming to see me. The thing is, they see doctors as interchangeable and medical care as an inconvenience, not as an opportunity to create a healthier life.
On the upside, I realize that the reason these three things irritate me so much is that they distract me from what I LOVE about medicine. Every minute I spend jumping through government and insurance hoops and filling out paperwork is a minute I can’t ever get back and spend doing what I love. The extra staff I need to deal with government regulations mean extra patients I have to cram into the schedule to pay the additional overhead expenses.
Every patient I see that doesn’t listen to me or take my advice is an appointment slot where I can’t see someone who honestly WANTS my help. The more patients I have to see in a day, the less time I can spend getting to know each individual patient and understanding their unique needs. When we decrease appointment times from 15 to 10 minutes so we can fit in more patients, we sacrifice quality in favor of quantity.
I don’t know where medicine is headed. The next 3 years will see major growing pains in the American health system. It will be an interesting time! However, I am reminded of an often quoted Chinese curse:
“May you live in interesting times.”