Our health system does little to encourage good doctoring

Sandeep Jauhar has this wonderful sentence in his New York Times op-ed, “Busy Doctors, Wasteful Spending”: “There is no more wasteful entity in medicine than a rushed doctor.”

And yet physicians are rushed. Dr. Jauhar writes about the payment system driving shorter visits. That problem represents an important component of undesirably short visits, but it is not the only problem.

The electronic health record adds documentation time, as do the billing documentation requirements. The bureaucratic requirements of CMS, insurance companies and meaningful use criteria all force physicians to spend more time documenting. Given constrained total work time each day (each physician sets a different constraint), a smaller percentage of time goes to patient physician time if a higher percentage time goes to documentation.

Add to that pre-certification calls, device forms, and telephone calls or emails (for which physicians do not get paid). We have a perfect storm.

Our notes should reflect our thinking and plans and include necessary data. Bureaucrats want more and require EHRs to demand more. EHRs are designed for billing rather than patient care. They take the focus away from the patient interaction.

Too many physicians my age are opting out. We have a physician shortage (just try to make a new primary care appointment) and we have a system that leads to burnout and thus less physicians.

When will the “suits” understand the problem? They won’t, because they have caused the problem. Physicians like interacting with patients, taking time to consider the problem, and solving patient questions. Our patchwork non-system does little to encourage good doctoring. And that should become the focus of all physicians.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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