Spend time talking with non-medical friends and acquaintances. Ask them about their medical experiences. Imagine what they want, or ask them what they want.
People want to feel that their physician has spent adequate time talking, examining and explaining. They want to look into the physician’s eyes. They want the best possible care, but caring matters.
Our “system” discourages such care implicitly. Physicians do not get paid to spend time with patients. Too often, part of our payment includes performance measures. Too often, we must enter data into computer systems designed to analyze data rather than to make our job better.
Our notes are no longer meant to communicate our thought process, but rather include physical exam points and review of systems points that make the note bulky and often unreadable. These “points” add nothing to the note, but CMS and many insurance companies believe that the note documents our work.
CMS and insurance companies, legislation and many administrators seemingly have no understanding of the impact of their rules on the patient-doctor relationship. I purposely listed patients first, because they suffer from how these external forces treat physicians.
Each rule, each administrative annoyance grew from a reasonable concern, but as usual, the instigators ignore the unintended consequences of their impositions. Yes, they add impositions on physicians and therefore the patient-doctor partnership. We spend too much time worrying about and fudging billing codes. We try to meet performance measures, even when they produce dangerous overuse.
Being a physician is a great privilege. We really do want to help our patients. Will someone let us? Will someone stop this madness?
And I do not want to hear that a train left a station or a horse left a barn. Of course, when the horse left the barn, you know what was left behind.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
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