Walking the hospital corridors, many of the comments I overhear patients and others speaking about doctors often amazes me. On this day, I took notice to the conversation of two elderly women who were none too happy with doctors, whom they stated only cared about their computers these days and not about their patients.
Upon hearing this, I wanted to scream out that nothing is further from the reality of what doctors truly feel. In fact, many days, a burning desire to toss my computer out the second floor window consumes me, but I rein it in. Doctors abhor spending time during the patient visit on their computers, documenting in the electronic chart. This decision was foisted on us by governmental mandates much against our wills. EHR (or electronic health record) technology was forced upon us as well as its antecedent meaningful use requirements. If we do not comply, we will be financially penalized, so we have little choice. I have published many articles on the topic.
Patients do not see this, however. They want our time, they need our eye contact, they need to know we care about their health. They do not want us keyboarding away while they open their hearts to us. It makes them feel insecure. It lets mistrust sneak in. This lack of trust is very harmful to the doctor-patient relationship in many ways. Perhaps, most important is that patients are less likely to follow our medical advice when the trust is not there. And, this can lead to unfavorable medical outcomes.
“The doctor is no longer center stage, unless you are watching a puppet show. We are now the supporting cast. Patients no longer have center stage either. The stars are the CEOs, the administrators who are raking in the big bucks…”
Reading or watching the media exemplifies the anti-doctor culture now prevalent in the US. Even in a State of the Union Address, our own POTUS Obama made the suggestion that doctors perform procedures for profit. He completely disregarded the integrity of most doctors who work long hours, studied for many years, and take great strides to give patients our very best care. The media clamors for us to be transparent about our charges, while many of us close our doors because we can no longer afford to practice. We see the stereotype the media portrays of us: greedy doctors driven for profit. Yet, how many of those journalists volunteered to visit our practices or even talk to us and see what it is like in the exam room and what we deal with on a daily basis? Far easier just to perpetuate a stereotype than to investigate the reality. Sure, there exist some greedy doctors out there. But, the truth is, the majority of doctors despise them because they give us all a bad name and cast us in an unfavorable light. Does anyone want to know what the average doctor is like? Or do we just want to hate them all in the same way because it pleases us this way?
The war on doctors flames in board rooms across the country, as healthcare executives discuss how to profit off of our work. They place no value on our expertise but rather calculate how they can reduce our reimbursements and get us to practice medicine in the way they desire to reduce costs and maximize their revenue. Doctors are not judged by clinical skills but rather by how much money they saved the insurance company. I receive these analyses quarterly from many of the insurance companies that I contract with. If I prevent my patients from going to the ED to obtain medical care or only prescribe them the cheapest medications, I earn a higher rating. Do we really want to be treated by doctors who know how to cut costs the most, or by those with the best medical skills and knowledge? Sure, we all need to be conscious of healthcare costs, but not by sacrificing the best care for our patients. Insurance companies see their bottom lines. I, and most physicians, see a patient in front of us in the exam room that we want to help, to cure, to heal, to prevent a bad outcome from happening. But, all too often, the insurance company overrides our medical decisions in order to save costs, not lives. How has the system lost its priority like this?
Unless, we stand up and demand changes, we are facing a future where the doctor no longer has much input into medical care.
And the government is no ally to doctors either. In recent years, laws and mandates have poured forth from the halls of the Congress and Senate putting more restrictions on doctors. These mandates do little to improve patient outcomes. There is no evidence available that they do, yet doctors are forced to comply with these regulations or face financial penalties. In fact, if you look further into these new laws, for example MU, PQRS, PCMH, it seems that these systems are just a way for the government to harvest more data about our patients. Do we really want that? And why is the government turning patients into data? In the future, doctors will be paid if patients meet certain clinical outcomes, like target LDL cholesterol levels, BP readings, and many more. Shouldn’t we be worried about the person and their health and not aiming for a specific target number? The governmental mandates are changing all this. And, to make matters worse, the government is the one establishing these guidelines. Do we really want our politicians deciding what is best for our health more than doctors do? Isn’t it time politicians removed themselves from practicing medicine unless they have earned a medical degree?
Unless, we stand up and demand changes, we are facing a future where the doctor no longer has much input into medical care. They will be forced to follow guidelines established by those without any formal medical training. And patients will be the biggest losers in this new medical world. They will no longer be a player in their own healthcare decisions. They will be relegated to what their insurance companies allow them to receive, based on cost alone. There will be no more private doctors or small practices. Patients will only be able to see doctors, if they are lucky, in large systems or hospital groups. They will no longer have a personal relationship with their doctor, who will now just be a cog in the wheel, signing off only on what he is allowed. The patient will become a number, like at the deli counter: patient in, patient out. And the patient will leave dissatisfied because they had to pay for the visit because of their high deductible. They were not able to receive any medications or tests they needed because the insurance company denied them…and they were too expensive to pay out-of-pocket. The doctor will be burnt out and the patient disgruntled. The government will have the data they need because the burnt-out doctor is forced to submit it under financial penalty. And the insurance company maximized their profits, with their CEOs and other administrators making annual salaries in the tens of millions of dollars (as already happens in the present day).
These are historic times for the US healthcare system. We are watching it destruct before our very eyes. The days of Marcus Welby type medicine long gone.
Yes, these are historic times in medicine as the curtain closes on the way we have trained and learned to practice medicine. The doctor is no longer center stage, unless you are watching a puppet show. We are now the supporting cast. Patients no longer have center stage either. The stars are the CEOs, the administrators who are raking in the big bucks and determining company guidelines and what doctors can and cannot do. The co-stars are the politicians, who issue mandates for their own gain, to push their own agendas and to line their own pockets.
The war on doctors is flaming. The American healthcare system is being destroyed.
Are we going to fight back? Or are we going to watch history unfold?
Dr. Linda Girgis MD, FAAFP, is a family physician in South River, New Jersey. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year. Over the course of her practice, Dr. Girgis has continued to earn awards and recognition from her peers and a variety of industry bodies, including: Patients’ Choice Award, 2011-2012, Compassionate Doctor Recognition, 2011-2012. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.