Doctors and nurses are being overloaded with menial tasks

Doctors and nurses are being overloaded with menial tasks

I’m no economist.  In fact I have never taken any business or accounting classes in my life.  But it doesn’t take a formal education to get this.  We are speeding down the wrong path.

The call at three in the morning woke me from a deep sleep.  I fumbled and strained to hear the whispered voice of the apologetic nurse.  Apparently Mrs. Thompson had scraped her arm against the wheel chair, and suffered a minor abrasion.  No harm, no foul.  Except that ever since the state had come in  and eviscerated the nursing home protocols, extra precautions were being taken.  Some things just won’t be left till the morning anymore.

My early trip to the hospital was no better.  My personal assistant called to say that I had to redo the form to get one of my patients a walker.  Although I had signed it by hand, we had typed in the date.  Apparently the medical equipment company required that the date also be written in ink.  It sounds minor, but I had to find a fax machine, wait for the fax to arrive, write in the date, and fax back.  All, of course, needed to be done immediately.

Luckily my hospitalized patient was getting better.  And since it was neither an admission nor discharge day, I just might escape without wasting too much time on paperwork.  As I was putting on my coat, the head nurse stopped me in my tracks.

“I just need to notify you that your patient claims she is missing fifty dollars, and can you sign this form acknowledging that you have been informed.”

What?  Since when did I become a policeman?  Since when did take charge of all criminal activities that take place inside the hospital walls?

Health care is being overrun.  Government induced regulation and documentation are creating mental gridlock.  The dictates of our forms and procedures are tying up those with the physical and intellectual know how to care for patients.

Why can’t you get an appointment with your doctor?  Why are diagnoses being missed?  Why is the quality of health care in the United States declining rapidly?  Stop querying big data and start looking at the hunched backs and sore shoulders of the people who are inputting that data.

We are turning our physicians and nurses into scribes, field workers, and secretaries.  Those who create the most value, who took the most time and money to train, are being overloaded with menial and level inappropriate tasks.

No small business would be naive enough to operate this way.

Why then, should one of the largest sectors of our economy?

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

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  • toolate

    There is only one way to stop this madness.

    No one will listen. No one cares. No ones gives a damn.

    They’ll keep abusing you – all the parasitic entities and bureaucrats – till you get up and walk away. There’s no other solution.

    • SteveCaley

      And it is no coincidence; it’s not that nobody else notices. It is a deliberate indifference; a planned ignorance, just like the days of lynching. Yes, medicine can be made to fail, same as a dam or a bridge or any constructed thing. But why?

  • Lisa

    Medicine is not a small business; it is a hugh business, so it would be foolish to expect it to run like a small business. Remember the small business failure rate is high – I have seen figures that as many of 50% of small business fail in the first five years. That said I don’t know if there is a solution for the sort of irritants you described. Forms and procedures have existed as long as I can remember, in business and medicine.

    • Kristy Sokoloski

      You are correct on that Lisa. I have always known forms and procedures to have existed for as long as I can remember. Also, some of the issues that are of such concern in today’s medical world are also the same ones that occurred not only 10 or even 15 years ago, but as far back as 50 or even 60 years.

  • Patient Kit

    Let’s not forget about all the people who used to do those menial tasks. You took their jobs. >:-(

    • Brunhilde

      Is this a joke?

      • guest


    • goonerdoc

      Don’t know if you’re joking or not, PK, but if you’re not, with all due respect, we took nothing away from anybody. Those tasks were summarily thrust upon us by the powers that be. Taking something would imply that we wanted them in the first place.

      • Patient Kit

        I was sort of joking with you docs. I know you didn’t “take” tasks you clearly don’t want. But the kernel of truth in my (bad?) joke is that the powers that be who forced that unwanted clerical work on you also took away potential work from non-docs who might have been happy to have that work. There must be some former support staff who feel replaced. But, to be clear, I absolutely understand that it wasn’t doctors who did the taking. Hope I cleared that up. I probably should have added a winky or tongue-in-cheek emoticon instead of just my faux mad face.

        • RenegadeRN

          I understand what you are saying PK.
          The ICU I worked at for many years could not have run without our unit clerk.

          Years later I worked a unit where there was no unit clerk,( hospital saving a buck) and simply keeping the phone answered ( by the RN!) was incredibly time consuming.

          I hardly think answering the phone constantly was the best use of my time and skill set.

        • Suzi Q 38

          My husband works for a city.
          When he was a city planner (about 20 years ago),
          they used to write out their reports to recommend or not recommend building projects and then give the reports to a secretary so that she could type them for the city council meeting.
          She no longer is expected to type the reports, the planners type their own reports.
          She has a lot of other duties. Other secretaries in that department were laid off.
          Typing your own reports were almost unheard of a 20 or so years ago. Now, it is expected.

  • NewMexicoRam

    Here’s a new one:
    A patient came in today with a large 11×14 mailer just loaded with “coupons” and said I had to fill these out. The mailer was from one of the local Medicare Advantage plans. It contained about 12 coupons that the “physician” had to sign and date, indicating the dates the patient had various screen tests and procedures done, including mammograms, pap smears, LDL testing, etc and etc. If the doctor filled in the dates of the tests, the patient could get $50 in rebate coupons for one of 3 local retailers. Yes, the doctor even has to check the box indicating which store the coupon would be good for.
    No, I guess the insurance company didn’t have time to look up in their own records that these procedures or tests had been billed for.
    I was tempted to say I’d do it if the patient gave me a $10 coupon, but I didn’t think the joke would be appreciated.
    I did NOT fill it out. Instead, I explained to the patient and adult daughter that this is the kind of thing that makes doctors very irritated at Medicare and insurance companies–more work that means nothing for the doctor, and really doesn’t add medical value to patient care.
    Amazingly, the daughter and patient agreed! Then they got into a discussion about how they are sick and tired of insurance games, angry about ObamaCare, and how they are going to vote against the Democrats who are destroying our health care system.
    Maybe denying to fill out those coupons will actually help this fall.

    • guest

      Good for you for standing up for yourself, and for our profession. For too long, we have deluded ourselves that we are being “professional” when we allow third party payors, hospitals and even our patients, to step on us. Only by speaking up, setting limits, and candidly explaining our disbelief and displeasure at some of these intrusions, will we be able to make any progress on getting them to stop.

      • Kristy Sokoloski

        I have been having to speak up more for myself and the profession, but there’s too many variables going on to explain why the healthcare system in this country has the problems that it does. As for the issue of the 3rd party payors I am not thrilled about it, but without the insurance company I would not be able to see my doctors and neither would my relative. That’s why it worries me about those doctors that choose to go direct pay or be in a concierge practice. Because while I understand why they are trying to do something to insure that they get their money there are going to be a lot more people that won’t be able to see their doctors as regularly as they ought to because they won’t be able to afford to pay. This is exactly why so many people in this country are not able to see the dentist regularly for cleanings and check-ups like they should.

        • Lisa

          I suspect many people don’t go to the dentist for cleanings on a regular basis becuase they hate going to the dentist, not becuase they can’t afford it. One thing about dental costs – it is easy to compare prices and dentists will work out payment plans with people – more readily than doctors.

          • guest

            Also, because dentists operate for the most part on a cash-pay basis, many more of them are able to volunteer their time at free clinics than are doctors. Low-cost dental care is also available at dental schools, something that used also to be the case at medical schools until our healthcare system was dismantled.

          • Lisa

            Free clinics and reduced fees at dental schools do not begin to meet the need for low cost dental services.

        • guest

          Patients who feel that their access to medical care would be adversely affected by doctors giving up on taking insurance do have something they can do to help: they can volunteer to pay the doctor up front and take back the burden of filing with their insurance company for repayment.

          Those of us who are 50 or older remember that this is the way that third-party reimbursement used to work. The problem is not necessarily that we have insurance companies. The problem is that in the 1990′s the insurance companies were clever enough to get doctors to (stupidly) agree to assume the role of a billing clerk and take responsibility for getting reimbursed directly by the insurance company.

          Once you have an entity who is not the customer (the doctor) trying to get payment from an entity who is not the customer (the insurance company), you have a situation in which the insurance company has no direct accountability to a customer, and has unfettered ability to behave abusively/fraudulently throughout the reimbursement process.

          This is exactly what has happened, and doctors have struggled now for decades with the increasing costs of hiring staff to deal with insurance companies. This has inflated healthcare costs, which has resulted in ever-more-draconian attempts on the part of insurance companies and the government to contain costs. Most of these attempts involve increasing amounts of paperwork for the doctor.

          It’s a vicious circle which has spiraled out of control. Patients could help by once again becoming the customer and dealing directly with their insurance companies, rather than expecting their doctors to pay for staff to do it for them.

          I personally have begun, whenever there is a problem with my medical insurance (which there frequently is, since I have United Healthcare), to cc my boss on emails to our HR people. This way she is aware that I and my doctors are being treated abusively by my insurance company, and that can be taken into consideration when my company is trying to decide whether to renew our contract with United.

          • Lisa

            I remember when patients were reimbursed directly by insurance companies. At that point in time, doctors had staff to manage their acounts receivable.

            I’ve never worked for a doctor, but I worked for a dentist doing insurance billing and collection work. I spent a lot more time make collection calls than I did on insurance billing. I think there is a reason doctors agreed to accept payment directly from insurance companies. Very few people I know could pay 100% for their medical treatment upfront.

          • guest

            However, since that time, insurance companies have “stepped up their game” in terms of corporate practices that create barriers to timely (or even any) reimbursement of doctors. Getting reimbursed by some insurance companies has become a complete nightmare, requiring much more office staff than previously. Because the doctor is not the customer of the insurance company, they have absolutely no recourse when confronted with fraudulent/obstructionistic repayment practices, unlike the patient, who can complain to their HR rep.

          • Lisa

            Doctors and hospitals do have contractual relationships with insurance companies. Doctors do have a recourse – don’t sign another contract with the insurance company. Of course, that may affect a practice’s income. If I am looking for a doctor, I would rather go to a preferred provider for my insurance company. Then I know exactly what my out of pocket costs will be and I have never had a problem with an insurance company denying a service.

            Doctors have another recourse to non-payment by insurance companies. Every time I see a doctor I have 1) pay the co-pay up front and 2) sign a form agreeing that I am responsible for all charges if my insurance company does not pay.

            Final point, not all people who have insurance have coverage through their employer.

            Going back to the good all days is not going to solve the affordability issues or reduce the hassel factor of practicing medicine.

          • guest

            “Doctors do have a recourse; don’t sign another contract with the insurance company.”

            Exactly. It’s called going into concierge or direct-pay practice and it is, in fact, the only recourse that physicians have these days. My comments about patients taking responsibility for dealing with their insurance company themselves were made in response to someone objecting to doctors going into concierge/direct pay practice.

          • Lisa

            You are right, but as the person pointed out, many patients could not afford a concierge/practice.

            Being in private practice means you are running a small business. Not every doctor has the skills to do so.

          • LeoHolmMD

            CMS/Insurance does not want the public to have any idea how absurd their practicies are, or how poorly physicians are treated. They also don’t want the public to get involved with reducing some of the more absurd pricing.

          • Suzi Q 38

            “….It’s a vicious circle which has spiraled out of control. Patients could help by once again becoming the customer and dealing directly with their insurance companies, rather than expecting their doctors to pay for staff to do it for them….”

            I remember doing this for doctors in the late 80′s and early 90′s. I paid up front, and then the insurance reimbursed me. Sometimes I did not get all the money that I paid out for the doctor visit.

    • Lisa

      Democrats are not destroying our health care system; I think you can lay that one at the feet of insurance companies and corporate medicine. The profit motive rules all.

      The coupons you were asked to fill out had nothing to do with medicare other than the fact that they were an attempt by the insurance company to gain data about medicare patients. I would be really curious how many were returned. i think most doctors would have responded as you did.

      • Kristy Sokoloski

        Unfortunately, it’s not just the insurance companies and corporate Medicine that is to blame for all of this. We are all (yes, I said “all” which includes patients as well) to blame for the destruction of the healthcare system. And it’s been being destroyed for longer than I have been alive and that’s 42 soon to be 43 years. As someone mentioned in their blog post about where are all the Primary Care Physicians in America there’s also been issue with the way Medical Schools have worked but yet this has been in place for a hundred years. And it’s very hard to change something that has gone on for so long in order to make it better than what it is. And the reason that it’s so hard to change this is because that’s all that’s been known for one hundred years. And when someone does try to change it they are met with resistance. The same is the case now.

        • Lisa

          There is no perfect system, for anything, anywhere and it is in the nature of systems that participants will resist change. But I do think corporate medicine is to blame for a lot (even most) of the current problems.

      • Patient Kit

        Lisa, I totally agree. By far, the #1 problem with the US healthcare system is that it is fundamentally, at it’s core, a big business driven by profit greedy entities like insurance, hospital corps and Pharma. As long as we allow the system’s main purpose to be making money, the problems and costs are only going to escalate. The profit driven powers that are making most of the money have incentive for healthcare to be more expensive, not less expensive.

        What has to change is our system’s main reason for being — the core purpose has to be providing good accessible healthcare for all, not making maximum profits at any human cost. I’m all for fair pay for doctors, but primary care docs being paid more is not going to fix all the problems. And more money for docs is not a rallying cry that will engage the patient support you need. Both patients and docs need to hone in on our real common enemy — the profit driven greedy powers that currently control our system.

    • LeoHolmMD


    • Patient Kit

      Why is a Medicare patient angry about Obamacare? How did the ACA adversely effect Medicare coverage? And what do those coupons have to do with Obamacare?

    • SarahJ89

      I agree you shouldn’t waste your and the patient’s time filling out coupons. It’s mind boggling, really, to have health care polluted this way.

      But Medicare Advantage has NOTHING to do with the ACA. And you know that. Is there some reason you did not set your patient straight on this FACT?

    • Suzi Q 38

      “…….Then they got into a discussion about how they are sick and tired of insurance games, angry about ObamaCare, and how they are going to vote against the Democrats who are destroying our health care system….”

      I would guess that there were a lot of doctors who voted for Obama and his heath plan.

  • Margalit Gur-Arie

    If HR3590 were about the government taking control of the financial aspects of health care by creating a single payer system, I would be out there supporting it in the streets, with a decent supply of French bubbly….
    If you actually read it (and the dozens of “adjustments” to it), it is about the government acting as a compulsory pass through mechanism for extracting the last dimes from citizens pockets and funneling them smoothly into the pockets of big corporations under the false pretense of providing medical care.
    The problem both conservatives and progressives are having is that government and big business are now indistinguishable from each other, rendering our differences irrelevant.
    The first order of business for the electorate should be to put some daylight between government and corporations. Then we can all revert back to our traditional ideologies and choose sides. Right now, there are no sides, and basically, we are all being taken for a ride….

    • SarahJ89

      “The problem both conservatives and progressives are having is that
      government and big business are now indistinguishable from each other,
      rendering our differences irrelevant.” If I knew how to do needlepoint, this quote would end up on a pillow.

  • Patient Kit

    IF ONLY the ACA was a route to converting to a single payer system! Then this phase of the ACA would be well worth it. As far as I’m concerned, a single payer system would be all about healthcare instead of the current system we have, which is all about profits. IF ONLY.

  • buzzkillerjsmith

    I like the graph. Graphs rock.

  • Alex Hunt

    I know, and agree, I have toe sign 3 forms everytme I send a patient home, or to another facility by ambulance. And then there is the form brought tome after a CT, saying I knew about the patients CR clearance, and that I had OK’d the CT

  • Lisa

    My response was to guest’s post (I have no idea if you are the same guest) about the difficulty of being reimbursed by insurance.

    I’d agree that a single payer system would be better than our current system, but I hardly think the rest of what you sugget makes the sligtest bit of sense.

  • Lisa

    ?? Corporate medicine, by definition, involves making a profit.

  • Lisa

    I don’t assume a big box is better than a small store. And in real life, I do not shop at big box stores.

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