I met with my staff yesterday to discuss the effect of a 27% cut in Medicare reimbursement on our patients and our office.  I had a really lousy day, explaining to my elders what would happen if Congress fails to act.  One of my patients aptly pointed out that Congress has not acted responsibly in the last 20 years and that it would take a miracle for them to get their act together in time to avert Doomsday.

I’m not sleeping well these days.  While talking to my staff, I realized that my heart is breaking.  The practice of medicine is my second love.  My family is my first.  My choices are untenable.

If I drop out of Medicare, I hurt my elders.  The elders in my community worked hard to build this country, putting money into Social Security and Medicare while saving for their futures.  They deserve more than Social Insecurity and the downgrading of Medicare into Medicaid.  Having to pay cash for medical care will drain their funds and spirits.

If I stay in Medicare, I will have to find a way to reduce my overhead by 27% or reduce the level of care that my patients receive by 27%.  How in the world do you reduce overhead?

“Hello, ComEd, I can no longer afford to pay my electric bill.  Congress says I can exist on 27% less.  Can you brown-out my lights or turn them off on weekends and holidays?”

“Hello, Mr. Landlord.  By Congressional order, I am sending you 27% less rent this year.”

“No, Mrs. Bashful, we no longer have patient gowns.  I’ll step out so you can take off your clothes.  Please just drape them over your torso.  What?  Yes, it is cold in here.  The gas company would not take 27% less so they turned off our heat.  I’m sorry; we had to let the nurses go.  If you are uncomfortable being alone in the exam room, we can reschedule your exam on a day when your husband can take off work and be here.”

Cutting overhead won’t work.  So, how do you give 27% less care?  You don’t.  You either give 100% care or no care at all.  You can’t rush elderly patients in and out of your office and still care for them.  You can’t limit yourself to a “one problem per visit” type practice.  Caring for the elderly is not a business.

The older a person gets the more complex his care becomes.  The older a person gets, the harder it is for him to get to the office in the first place.  I can’t imagine telling Mr. Elderly that I can only take care of his sore throat today and that he’ll have to come back in the morning to address his sore hip.  And, by the way, he should make an appointment next week for his blood pressure:  and, while he’s at it, he might as well make another appointment for his diabetes.  Yes, I know it’s winter and there is ice on the sidewalks.  “Mr. Elderly, you have enough problems, please don’t fall and break yourself.”

“I’m sorry, Mr. Elderly.  I know you have been here 15 times this month.  The country is now on the “Great Austerity Program of 2012” and we won’t be able to get to your erectile problem until we resolve your hemorrhoids, depression, ulcers, skin rash, and sleep disorder.  Those problems should only take another month or two.  Please be patient!”

Yes, my heart is breaking.  I’m watching my second love die of Congressional neglect and mismanagement and there is nothing I can do.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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