Originally published in HCPLive.com
by Alan Berkenwald, MD
William Osler is known as the Father of American Medicine. He was a world class physician, the “Doctor’s Doctor” – as physicians all along the Atlantic seaboard would sent their family members to him.
He wrote the first American medical textbook. He was so good, he was recruited from Johns Hopkins (which he had turned into a premier medical center) to Oxford, and he never practiced in America again. He left a complicated legacy. He was a clinical giant. He was the first to describe many disease processes. He invented ‘rounding’. He taught that all acute symptoms should be related to one illness only. He was the first Academician to recognize the impact of poverty upon disease, and the hopelessness that prevents compliance and healing. So, he invented social workers.
Maybe that’s why he never returned to America.
Working in a hospital, I spend far more time practicing social work and case management than I do medicine. In a 10-hour shift, my time is not spent on the noble art of diagnosis and treatment. I have little time to spend at the bedside. I spend my day completing forms for medications and durable goods, of arranging home oxygen and out patient therapies, of transfers and nursing home placements, of signed consents and health proxies. I spend hours on the phone coordinating specialists and discharge plans.
It’s a wonder I have any hours (and I do mean hours) left to do computer order entry – one click at a time – before doing medication list reconciliation forms.
My most important rounds each day are with case management, not the nurses.
I am now skilled in the art of insurance coverage – explaining to patients and families why their insurance won’t let them stay for another day, or cover that medication, or allow home therapies, or cover visiting nurses and personal care attendants. Why they can’t be transferred to a Medical Mecca. Why their stay in the hospital is an “Observation” and not an “Admission,” so not eligible for nursing home coverage.
Does anyone notice that I still practice medicine . . . on the side?
It’s no wonder why William Osler never practiced medicine again in this country.
Alan Berkenwald is an internist who blogs at In the Name of Medicine
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{ 10 comments… read them below or add one }
The Osler story is charming. In the 19th century we treated symptoms, in the 20th century we treated diseases, in the 21st century we’ll preemptively diagose and predict disease. Throw in the admin hassles that you describe and it leaves us to wonder what is the role of a primary care physician? I suspect that the role of physicians in the next generation will be unrecognizable to the current population of docs.
I bet ER docs and nocturnal hospitalists can avoid nearly all those hassles, focusing on diagnosis and treatment of sick folks instead.
Many years ago I got a Saturday morning hospital consult from a older Neurosurgeon. After I rushed up to the floor to do the consult, I read his note “Reason for the consult: fill out nursing home forms”. This is now the real world for primary care docs: filling out forms designed by lawyers for little or no reimbursements.
Osler was Canadian, not American.
@TrenchDoc: Please tell me you refused?
As a physician with a hospital and a private practice, I can tell you this type of thing goes on in both places. At least in the hospital, I have medical social work help. Recently, I saw an outpatient as a consultation in order to fill out driving forms. His regular physician couldn’t get him in soon enough.
Nuclear Fire,
Unfortunately, I was a newbbie and had been trained that all Neurosurgeons were Gods and that since I was only a lowly internist, I should submit to their demands.
Brad,
I had a son of one of my patient’s create a major uproar when I refused to see his mother after 3 pm on a busy Friday afternoon to fill out her nursing home papers. He was just “too busy” to bring her in any other time.
Trench:
Specialists get these requests too. when I receive them, I make it clear that these are administrative services subject to my administrative service fee scale and which cannot and will not be submitted to an insurer since it is not for clinical services. Payment is prepaid and substantial enough that everyone understands that time is money.
I agree completely with above. Doesn’t this make you feel like quitting medicine and doing something more satisfying.