Evidence-based medicine is ok if put in proper perspective and is not the end all as it only deals in percentages, which is ok if determining if eye patches help eye injuries heal faster, but not if you are using it to determine whether or not to give the guy who only comes in once a year an EKG.

Is it ok for percentages to be the basis for running an EKG, when you are in the 1% that it would have saved your life??? Does evidence based medicine take into account family history, patient’s early adulthood bad habits, environmental exposures, etc? Every person is an individual, and patient’s peace of mind about their health is just as important as early diagnosis and a comprehensive exam when done well may not help your bottom line, but it will raise patient satisfaction and your outcomes. (Any disease state that is discussed through the lab follow up and during the physical exam you can charge a regular E&M visit code, plus you can charge for EKG, Immunizations, plus get paid for the physical exam.)

God forbid that anyone would believe that Medicine could eventually be boiled down to going to a kiosk at a mall, putting your head the machine pricking your finger and it spits out a diagnosis and a script, just because “evidence-based” medicine states that seeing a physician for a diagnosis only saves 40% of lives.

I’ve been on sides of the physical and I have to say I like it when a physician takes a little time to actually examine me. Most of the things that an expensive lab workup would pick up can be picked up as effectively with a few minutes of exam. I saw a doctor once who ordered a rather extensive liver workup (only left out the biopsy) and DID NOT examine my abdomen, eyes or anything. Because he was the only doc on my health plan at the time, I decided I would rather be gravely ill than visit him again.

of course, evidence based research has found little to any relationship between a regular physical and improved outcomes

then why are doctors so attached to it . . . ah yes, see above.

For the record, I do a physical exam but a anything more than a 2/6 murmur gets an echo regardless of whether I do hand grip maneuvers anymore.

Either continue to pretend to practice medicine going through the motions and in effect committing fraud while making the most money you can make and letting third parties drain your of your professionalism or refuse to constrained by that 15 minute limit. Who says you only have 15 minutes? Not the insurance company. They don’t care how long you spend. They just aren’t willing to pay you for the time to do it right. Afterall, it isn’t their health. You can take as long as you like. Up to a point you can do it and cover your expenses too–you just have to live lower on the hog.

On the other hand, you can take charge of the economics: Define how much time you need to do the kind of professional work that you can be proud of. Determine a fair professional fee for that time. Refuse to engage in any insurance contracts that do not let you collect that fee.

But to do a sloppy job just to keep the revenue stream where you want it is morally indefensible. A history and exam are the basis of clinical medicine. If you aren’t doing that, you aren’t practicing medicine–you are in some other kind of business masquerading as the practice of medicine.

anon MD

Doctors claim they spend lots of time worrying about malpractice claims, and there must be significant time involved ordering and reviewing “defensive medicine” tests which they claim they do solely to avoid litigation. Not to mention all the time and money they spend lobbying on the issue.

Given that the relationship with the patient is the key to reducing malpractice claims, it would seem that there ought to be plenty of time to do a proper physical exam and thus improve that relationship.

Barbara Ficarra

http://snipurl.com/hsyhr