Monday, February 6, 2017

how will your story end?

photo thanks to Andrea Lauren

In my last post, I connected my decision to retire at an early age (if sixty is considered early…) with the evolution of a health care system that has become highly technical and increasingly impersonal. While this transformation may offer some advantages in terms of efficiency and productivity, it jeopardizes the patient/physician connection and ultimately, imperils the patient’s ability to heal.

I closed my practice after thirty years in Family Medicine because working within the system scared me. I told my patients and colleagues I was retiring…when I meant that I was quitting.


I didn’t put it quite that way, of course. It wasn’t as though I simply got fed up with things, turned in my stethoscope and tongue blades, and slammed the door on my way out of the office. I wasn’t impulsive about it at all. I agonized over the decision years.
I didn’t leave because of the long hours, or the fact that I’d been running hopelessly behind schedule all day, every day for three decades. I didn’t leave to take an easier position or to make more money. I didn’t ask to be excused because of fatigue or forgetfulness or ill health.
I didn’t retire because of the oppressive paperwork or its successor--an oppositional-defiant EMR system. I wasn’t defeated by our baffling coding and reimbursement system. The ever-present threat of litigation. A pharmaceutical industry that invests as heavily in marketing as it does in research. A health insurance industry whose number one priority is corporate profit.
That wasn’t what got to me. The problem was that, in an effort to see more patients faster, I was forced to send patients on their way knowing that I hadn’t heard the full story. I often sensed that something else was going on…some issue I didn’t have time to explore. For instance, why a patient’s breath reeked of alcohol when he had an appointment for a sore throat at nine-o’clock in the morning. It took me ten minutes to diagnose and treat his throat, while his alcoholism went untended. Who had time?
In an effort to squeeze more patients into the schedule, important parts of their stories were being missed, and that scared me. Failure to diagnosis is the #1 basis for malpractice claims in this country. Worse, I worried that a patient would suffer or die because I didn’t have time to hear the whole story.
What finally got to me was the erosion of my authority as a competent and caring physician by self-proclaimed intermediaries who had neither knowledge of nor concern for my patients’ wellbeing. By business managers who failed to understand the importance of the patient/physician relationship, and how it impacts the patient’s ability to heal. By corporate geniuses who dismissed the power of eye-to-eye contact, the importance of undivided attention, and the gift of understanding in favor of productivity quotients and RBRVS units.
In the end, the risk to my patients outweighed everything I held sacred in medicine. In the end, I had to leave.
End of story. End of rant.


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