Patients: Accept your fate as a hamburger


Most of the doctors I know went into medicine because they really truly wanted to help people. But medicine, long honored as a calling as well as a profession, is facing some tough new challenges. Many doctors are disillusioned or simply burnt out. Others have accepted their fates as interchangeable provider units.

The name of the game today is efficiency — i.e., seeing as many patients as possible per hour, per workday, per month and per year. Doctors who have mastered this technique do well within the changing health care landscape. Doctors who don’t are pariahs.

So how does this affect you, the health care consumer?

Truthfully, not very well.

How well can a doctor get to know you in fifteen, much less ten or even five, minutes? What important information can be missed as the time spent with you shrinks and shrivels down to a hastily-administered encounter?

Efficiency, efficiency, efficiency! This is the call of the day as business managers attempt to squeeze every last penny out of the clinic schedule. It’s very different from what I expected while in medical school. It throws out the window and into the dumper the whole concept of “holistic medicine” — of getting to know your patient as a whole person, mind, body and spirit. Patients are relegated to their chief complaints and the emphasis is on “how quickly can we move this patient out of the room?”

“Treat and street,” long the mantra of ERs, is also becoming the daily directive in primary care offices.

Part of the problem, pure and simple, is economics. Office overhead keeps rising while reimbursements are not commensurate with services rendered. So the only way out of the bind is taking on increased patient volume. You become the McDonald’s of health care by processing the maximum number of patients. Patients, seen in this context, are hamburgers and doctors are line workers preparing the hamburgers. The disproportionate emphasis on time makes many doctors cranky and short-tempered.

Remember, you’re the hamburger that the line worker has to process. There are many more just like you to process each hour. And the line worker may not even get a lunch break.

But the hamburger analogy goes only so far.

After all, botch a hamburger and you can start over. Botch the care of a patient and it’s not so easy to remedy. So doctors, being the rather intelligent and resourceful folks that most of them are, develop shortcuts. It’s both an art and a science. Kind of like medicine itself. Except it’s closer to juggling with fire or sword swallowing. One has to be very careful indeed. These shortcuts allow them to process patients most expeditiously while avoiding medico-legal pitfalls.

So the next time you see your doctor in his or her primary care office, remember that he or she probably went into medicine to help people just like you. Understand too that although he or she would like to spend more time with you, it’s just not possible in the health care environment of today.

And the signs on the wall tell us this scenario will likely worsen. A serious shortage of primary care physicians already exists and is expected to reach the critical breaking point in the next several years. This, combined with our increasingly elderly population and millions more people entering an already taxed system, yields a somewhat gloomy and apocalyptic picture.

Clinics will be full. Your wait time to see the doctor may increase. You may not even get to see a doctor at all — you may be seeing a PA, Nurse Practitioner, or RN instead.

So what can you do to help your busy doctor?

Be respectful of his or her time. Cut to the chase of why you’re there or what’s bothering you. This isn’t a “social visit.” The days of being able to sit around and schmooze with your doctor are gone forever. The system simply does not support it.

Accept your fate as a hamburger – I mean patient. And be nice. Doctors, as busy as they are, are more likely to go out of their way for nice patients than for mean, nasty, overly demanding ones. Realize, too, that your doctor is striving and reaching daily to be the most caring and compassionate person possible, given the new emphasis on efficiency.

And it’s no slam dunk.

Joel R. Cooper is a family physician who blogs at his self-titled site, Dr. Joel Cooper.

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