Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Doctors are playing a very difficult game of changing rules

Emily Gibson, MD
Physician
August 12, 2015
563 Shares
Share
Tweet
Share

shutterstock_161298866

“The chief difficulty Alice found at first was in managing her flamingo: She succeeded in getting its body tucked away, comfortably enough, under her arm, with its legs hanging down, but generally, just as she had got its neck nicely straightened out, and was going to give the hedgehog a blow with its head, it would twist itself round and look up in her face, with such a puzzled expression that she could not help bursting out laughing: and when she had got its head down, and was going to begin again, it was very provoking to find that the hedgehog had unrolled itself, and was in the act of crawling away … Alice soon came to the conclusion that it was a very difficult game indeed.”
– Lewis Carroll from Alice in Wonderland

Navigating the U.S. health care system these days reminds me of Alice’s dreamscape game of Wonderland croquet.  A physician is given a flamingo mallet and a hedgehog ball and ordered — by the Queen at the risk of having one’s head lopped off — to go play, but the mallet won’t cooperate and the ball keeps unrolling itself and crawling away.  Just like any day in a medical clinic, a doctor’s time is spent trying to manage their flamingo and the patient gets tired of waiting,  so gets up and leaves.  At least Alice gets a good giggle out of it, but the reality in health care causes more tears than laughter.   We are playing a very difficult game of changing rules and equipment.

The flamingo in the doctor’s hands could represent the increasingly time-consuming requirement now to search over 68,000 ICD-10 diagnosis codes rather than the previous 14,000 ICD-9 codes.  Or the requirement to search for a 10 digit NDC number for any prescription medicine sent electronically to a pharmacy.  Or the meaningful use criteria that regulate mandatory data collection and reportage on patients to the Federal Government in order to receive full payment for Medicare or Medicaid billings.  Or the newly updated HIPAA and HITECH electronic security requirements to ensure privacy.  Or the obligations to the new accountable care organization that your employer has joined.  Or the maintenance of certification hoops to jump through in order to continue to practice medicine.   The exasperated and uncooperative “managed” flamingo keeps curling itself around and looking at us with a puzzled expression: Just what is it you were supposed to be trained to do?  Is there actually a patient to pay attention to in all this morass of mandates?

And the poor hapless hedgehog patient is just rolled up in a ball waiting for the blow that never comes, for something, anything that might look like health care is about to happen.  Instead there are unread notices of patient privacy to sign, as well as releases to share medical information to sign, agreements to pay today’s co-pay and tomorrow’s deductible and whatever is left unpaid by Affordable Care Act insurance, passwords to choose for patient portals, insurance portals, lab portals and healthcare.gov.  It might be easier and less painful to just crawl away and hide from that bumbling physician who can’t seem to get her act together.

I wish I were laughing, but I’m not.  As both physician and patient, it’s getting harder and harder to play the game that is no game at all.  The threat of losing credentialing in an insurance plan, or getting poor ratings on anonymous online physician grading sites, or being inexplicably dropped from a provider list, or too unproductive to remain in an employer medical group, or losing/forgoing board certification is like a professional beheading.  We keep trying to juggle the flamingo motivated by those threats, all the while ineptly managing the managed care system, and hoping the patient won’t walk away out of sheer frustration.

It’s hard to remember why I’m in the game at all. I think, at least I hope,  I wanted to take care of people, heal their illnesses and help them cope with life if they can’t be healed.  I wanted to provide compassionate care.

It is enough to make a doctor cry.  At least we can meet our patients at the Kleenex box and compare notes, and maybe, just maybe, we’ll find enough common ground to even share a laugh or two.

Emily Gibson is a family physician who blogs at Barnstorming.

Image credit: Shutterstock.com

Prev

Cerner beats Epic in the DoD sweepstakes. What does that mean for the rest of us?

August 12, 2015 Kevin 0
…
Next

This is why the humanities are important in medicine

August 12, 2015 Kevin 2
…

Tagged as: Primary Care

Post navigation

< Previous Post
Cerner beats Epic in the DoD sweepstakes. What does that mean for the rest of us?
Next Post >
This is why the humanities are important in medicine

More by Emily Gibson, MD

  • This family physician is deeply disappointed in maintenance of certification

    Emily Gibson, MD
  • Advice physicians should follow. But don’t.

    Emily Gibson, MD
  • I’m grateful to be open for business. This doctor is in.

    Emily Gibson, MD

Related Posts

  • Physicians who don’t play the social media game may be left behind

    Xrayvsn, MD
  • Why is it so difficult for Americans to make doctors’ appointments?

    Peter Ubel, MD
  • She sees difficult patients, but is a difficult patient herself

    Kristin Puhl, MD
  • Why do doctors who hate being doctors still practice?

    Kristin Puhl, MD
  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • Why medical school is like playing defense

    Jamie Katuna

More in Physician

  • A physician’s cry in light of world events

    Fareeha Khan, MD
  • 10 things to know about your doctor that will get you better care

    Dawn Sears, MD & Kim Downey, PT
  • Physician burnout reimagined

    Claudia Finkelstein, MD
  • Government surveillance: How electronic prescription records are changing medicine

    L. Joseph Parker, MD
  • Intensive caring: Reminding patients they matter

    Harvey Max Chochinov, MD, PhD
  • Empowering health care workers amid consolidation

    Anonymous
  • Most Popular

  • Past Week

    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • There’s no place for “benevolent deception” in obstetrics

      Megan Nix | Conditions
    • A physician’s cry in light of world events

      Fareeha Khan, MD | Physician
    • Drug prices and fast approvals can harm patients

      Martha Rosenberg | Meds
    • Embracing the Huntington’s disease community

      Erin Paterson | Conditions
    • Navigating the evidence-practice gap in concussion care

      Sohaib Kureshi, MD | Conditions
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Gaza’s medical crisis

      Tammy Abughnaim, MD and Emily Hacker, MPH | Physician
    • Antisemitism is at a historic high not just in other countries, but right here in America

      Joshua D. Lenchus, DO | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • Medicine has become the new McDonald’s of health care

      Arthur Lazarus, MD, MBA | Policy
    • Rising nurse practitioner burnout: charting and work-life balance

      Erica Dorn, FNP | Conditions
  • Recent Posts

    • Embracing the Huntington’s disease community

      Erin Paterson | Conditions
    • Unlocking the potential of allied health roles for a thriving health care system

      Eric Stastny, MHA | Policy
    • A physician’s cry in light of world events

      Fareeha Khan, MD | Physician
    • Protecting your health from environmental threats [PODCAST]

      The Podcast by KevinMD | Podcast
    • Efficient staffing partners for health systems

      Patrick Dotts | Policy
    • 10 things to know about your doctor that will get you better care

      Dawn Sears, MD & Kim Downey, PT | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 88 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Very Young Children in HIV Treatment More Likely to Die
  • Matt Rife vs Plastic Surgeon; Why Is Everyone Coughing? Running-Induced Crying
  • Rude Awakening on Trying to Keep Donor Hearts Usable With Common Hormone Infusions
  • Breast Cancer Screening Frequency Makes a Big Survival Difference
  • ChatGPT's Birthday Message; Journal Softens on AI; Healthcare AI Tracker

Meeting Coverage

  • Breast Cancer Screening Frequency Makes a Big Survival Difference
  • Noninvasive Therapy Shows Efficacy in Non-Muscle-Invasive Bladder Cancer
  • Combining Immunotherapy and PARP Inhibition in Advanced Uterine Cancer
  • Deep-Learning Model Shows Promise for ADHD Diagnosis in Teens
  • AI Model Can Predict Breast Cancer Risk Regardless of Patient's Race
  • Most Popular

  • Past Week

    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • There’s no place for “benevolent deception” in obstetrics

      Megan Nix | Conditions
    • A physician’s cry in light of world events

      Fareeha Khan, MD | Physician
    • Drug prices and fast approvals can harm patients

      Martha Rosenberg | Meds
    • Embracing the Huntington’s disease community

      Erin Paterson | Conditions
    • Navigating the evidence-practice gap in concussion care

      Sohaib Kureshi, MD | Conditions
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Gaza’s medical crisis

      Tammy Abughnaim, MD and Emily Hacker, MPH | Physician
    • Antisemitism is at a historic high not just in other countries, but right here in America

      Joshua D. Lenchus, DO | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • Medicine has become the new McDonald’s of health care

      Arthur Lazarus, MD, MBA | Policy
    • Rising nurse practitioner burnout: charting and work-life balance

      Erica Dorn, FNP | Conditions
  • Recent Posts

    • Embracing the Huntington’s disease community

      Erin Paterson | Conditions
    • Unlocking the potential of allied health roles for a thriving health care system

      Eric Stastny, MHA | Policy
    • A physician’s cry in light of world events

      Fareeha Khan, MD | Physician
    • Protecting your health from environmental threats [PODCAST]

      The Podcast by KevinMD | Podcast
    • Efficient staffing partners for health systems

      Patrick Dotts | Policy
    • 10 things to know about your doctor that will get you better care

      Dawn Sears, MD & Kim Downey, PT | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Doctors are playing a very difficult game of changing rules
88 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...