While on the way to a national meeting on health and public policy, I ponder on what the practice of medicine has become and whether this meeting will provide any hope for improvement. It hasn’t been clear to me that those most responsible for public health policy are listening to doctors. Politicians have been leading this charge, sometimes solo, sometimes in a group but rarely in a collaborative fashion — and mostly without the requisite experience or knowledge that appropriate collaboration can provide.
I think back to one of the seemingly endless coding and quality meetings in modern medicine as I talk with my patient. Every disease process must be documented meticulously (and at least once yearly, as Medicare forgets that the patient has had an amputation or has life-threatening pancreatic cancer on January 1st). We, as dutiful providers (becoming a more common term than doctors), must document the complexity of the patient carefully and continuously to prove to the insurance company that we are high-quality and reasonable cost providers of care — or bad things can happen. For example, if we become non-preferred by an insurance company, then patients may have to pay much larger co-pays or may not be able to see us as we can become out of network.
OK, here goes: diabetes and neurological manifestations, diabetes, and ophthalmic complications, diabetes and kidney disease, morbid obesity (being careful to select the box BMI 40-44.9), diabetes controlled on long-term insulin. These items and many others are how I describe Sally in the computer. Sally who likely does not want to be thought of in these ways, but instead wants to be seen and heard for her humanity. Sally who wants empathy and time, and someone to help figure out how she’s going to afford her next box of insulin or why she keeps gaining weight. Sally who wants to determine how to handle the sadness she feels, the difficulty sleeping and is concerned she might lose her job. (Oh wait! These are two more codes I need to add to the ever-growing list — major depressive disorder, moderate, not currently in remission and wait for it — there is a code for “threat of job loss.”)
Medicine and art used to be intertwined. The doctor was the artist and healing was his art. (Yes, it used to be only “his,” so some things have changed for the better.) But where is the artistry in modern medicine when so much time is spent behind the computer (by some estimates twice as much time as that spent with the patient)? It is not like my daughter who is filled with wonder on her iPad sketch program drawing using the latest technology to improve her art skills. Instead, modern technology is frequently a hindrance to patient care and joy in practice, a dreary and soul-sucking experience plodding through ICD-10 codes and click boxes designed to revolve around billing instead of patient care.
I continue to be hopeful with efforts such as Patients Before Paperwork and many others created by medical societies, that the powers that be may listen. The current political climate is incredibly distracting, but what is even more distracting is getting sick. John McCain, for example, likely has a new perspective on health care as he now needs to be a regular recipient. But we don’t just need recipients of our broken health care system at the table; we need the providers — the doctors, nurses, physician assistants, pharmacists, occupational and physical therapists, mental health experts and others.
Our next version of health care needs to move beyond sick care and box-clicking into a transformative and collaborative space. Where everyone works together at the top of their license to provide personalized care in a team approach. In healthcare 3.0 (as described by Zubin Damania, MD). We can use the computer as a tool, not for billing but to allow for communication and care for the patient all of the time (not just when they are in the office). So, if the national leadership cannot or will not improve health care, there are innovative companies working on exactly that. They are partnering with insurance companies so that health care teams are not paid based on the number of patients they see in a day and the number of boxes they click, but instead on the quality of the care they provide. Their incentive is not to shuffle patients in and out the door, but to provide high-quality health care all the time by whatever means necessary using the techniques inherent to population health. There are solutions. Health care providers really do want to provide high-quality care yet keep the humanity and art of medicine without losing their soul in the process.
Lianne Marks is an internal medicine physician. The opinions expressed are those of the author and do not represent any group to which she belongs.
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