Of the myriad of proposals meant to change the health care system, including switching to electronic records, paying for performance, and adhering to evidence-based standards, very little attention is being paid to how they will be implemented, and the unintended consequences that may arise.

Annie Brewster, an urgent care provider in Boston, outlines this in a nice commentary: “Reform should make my job more, not less, satisfying. Of course, doctors should be expected to offer the highest quality care in the most cost-effective manner, but policies must be built on a foundation of trust in physician motivation and competency. Most physicians have a sound knowledge base, and are driven by a genuine desire to take care of people and ‘do no harm.’ Professional autonomy must be protected. Instead of imposing mandates and restrictions from above like an authoritarian parent, policy makers should work to provide physicians with the tools to meet these expectations.”

She goes on the cite the problem of converting to digital records as an example. Although the intent is good, often times the systems don’t have a user interface friendly enough to make a doctor’s job easier. As Dr. Brewster correctly notes, “documenting electronically often takes more time than writing in a paper chart, [and] patient portals that allow for email communication with one’s doctor, while clearly beneficial to patients, can often feel burdensome to doctors-just one more thing to check in an already unbearably busy schedule, and extra time for which we are not compensated.”

Reform needs make physician satisfaction an explicitly stated goal. None of the changes will be widely implemented if they are met by grumbling resistance by doctors and nurses. Mandating them will only cause more doctors to leave the field already beset by access problems. And when that happens, who will patients, already waiting months to see a doctor, turn to?