It is getting harder to love your doctor these days. This cultural shift has nothing to do with the practitioners competence, rather with efficiency demanded by hospital affiliations and insurers. Americans still love the men and women we trust to keep us upright and taking nourishment, but the trust is becoming a blind trust as we don’t really know them and they know us only in a narrow clinical sort of way. I don’t know about you, but I miss the “old” days when you could look your doc in the eye and discuss the implication of his or her arched eyebrow while perusing your latest blood chemistry report. Various medical groups are very good about publishing the restrictions on and changes to the doctor-patient relationship from the doctor’s viewpoint. Let’s have a look from a patients perspective.
When I began my career as a rural highway patrolman, every trooper in the county knew, by name, every doctor in the county. As an example, my son was delivered by an obstetrician in the county seat, precisely two days after my last contact with this doctor in the emergency room of our local hospital where he was working feverishly to keep a young man alive who had been involved in a car accident. In those days, all of the doctors in the area took a turn in the emergency room, and were surprisingly adept at stabilizing patients for the helicopter ride to Kansas City where a specialist or trauma surgeon took over. There were three practicing physicians in my assigned town, all primary care doctors, two of which were married to each other. I can recall two specific instances of old style medicine that illustrate relationships long since relegated to the dustbin of medicine. On one occasion, having been stricken with some virulent, devastating bug causing me to vomit relentlessly, a phone call and two block drive found me bent over my doctors dining room table, in his home, awaiting the welcome relief of some powerful, injected potion that put me to sleep and dramatically slowed the wretching. On the second occasion, I was attempting to start a metal fence post into hard ground by standing on the “wings” of the post and jumping up and down. My boots were not up to the task, and one of the wings cut through a boot and into the sole of my foot. It was Saturday, and a call to the doctor resulted in his meeting me at his office downtown where he stitched up my foot and made sure my tetanus protection was up to snuff. The point is, doctors in those days practiced medicine, with few of the limitations that today’s highly specialized and efficient medicine requires. There was a personal touch….
This is not a political hit piece, however it should be noted that Barack Obama threw billions at a strategy involving the electronic health record system in use today. His EHR strategy would save billions he said, specifically 77 billion a year, create jobs and virtually wipe out Medicare fraud. Oops. This strategy actually greatly FACILITATED Medicare fraud and crushed many one horse medical practices as the costs of this equipment was prohibitively expensive. These doctors in small group or independent practices were forced into hospital affiliations or otherwise swallowed up by big practices. To us, the patient, evidence of this shift in the personal aspect of medicine is the appearance of your doctor, entering the room pecking away at his or her tablet, making little if any eye contact with you and leaving the room minutes later still pecking away at the computer. If your doctor didn’t adapt, there were instant penalties, on an annual basis, withholding a percentage of their Medicare payments…..already shamefully low. Efficiency? Perhaps, but at what price? It is estimated that ER doctors spend 43% of their time entering electronic records information and 28% actually with patients! Your average PCP now spends, on average, 48 minutes daily just entering clinical data. For us, the patient, the doctor spends considerably less time listening, and examining and more time pecking away.
Recently, I enlisted the services of a pain management doctor, a very nice young doctor, to help with chronic arthritic pain in my back. He spent 11 minutes with me and adjourned to the computer rack at the nurses station, making a record. Our conversation was exceedingly brief and his hurry was such that through an open door to my examining room, as I was putting my shirt on, he asked if I was suicidal or depressed! (He was entering a prescription for a med that I could not take as the FAA will not let you fly if you take it.) I told him no and walked out with a prescription that was useless to me. A few minutes of conversation would have cleared the air on this matter, but he was already in a room with his next patient. It is not about the patient, it is about the allotted time per patient and the necessity to see X number of patients per day to meet your quota.
As a final note. Doctors should know that we see the deteriorating relationship with them, on a personal basis, and don’t like it. There is little that we can do, however. Good medicine requires the sharing of deeply sensitive information with a member of a revered profession who we feel like we know well enough to be entirely candid. Today, with a single keystroke, the information you just shared populates fields in data systems virtually nationwide. For those of us fortunate enough to remember the old days when you could schedule time with a doctor who knew you by name, cherish the memory! Today, unless you are exceedingly fortunate, your name has been replaced by a numerical code, establishing the level of visit and a number indicating your time slot on a computer generated schedule. Do not dare to mention, during a visit to follow up on a sutured laceration, that you have been noticing a swelling on your arm. That is another time slot on another day.
Times have changed and we have to accept that, but we don’t have to like it!