Saturday, March 12, 2011

Why I Feel Shame

Why I feel shame:

1)Because every damn health care article I read somehow finds a way to quote "To ERR Is Human"

2)Because every discussion about torte reform ends up being a soliloquy about those "Bad Doctors".

3)Because every year a new governmental regulation adds a new piece of paper I have to fill out or a new computer screen I have to click through to do my job. Now to discharge a patient I have to fill out three separate forms. Last year it was two. The year before I could give a verbal order (the quality of care has not changed).

4)Because the government gives lip service to improving primary care but just doesn't get it. Now to get home health for my patients I have to fill out even more paperwork....this is not stopping people from using home health is just taking up more of my time.

5)Because when I send my patient to have a swallow eval, the speech therapist sends them to a pulmonologist for their cough, and then the pulmonologist sends them to a neurologist for their dizziness. And after thousands of dollars of workup the specialists come to conclusions that I had already told the patient and documented in the chart but no one took the time to ask me because what does a primary care doc know anyway?

6)Because for some reason when patients get sick and die the first question society asks is....Who messed up?

7)Because sometimes I get so involved in using my emr, figuring out eprescribe, or making sure that I have documented correctly for billing purposes that I don't "hear" what my patient is so desperately trying to tell me.

8)Because sometimes, god forbid, I am having a bad day and may not perform to my peak level....somehow that doesn't feel OK anymore.

9)Because I am deathly afraid of my government...breaking down my doors, looking at my records, and asking for money back. Even though certified coders themselves rarely agree with each others findings.

10)Because I used to practice under the assumption that I was being look at under a I feel like I am practicing under the gun.

11)Because I secretly worry....that with all the doctor bashing and painting us as knaves in the day a disgruntled patient will walk into my office with a gun and start shooting.

12)Because I went into this profession with such pure and innocent motives...

I wonder how it all became so convoluted!


Maggie said...

Why I sympathize -- and why I wish you didn't have to feel shame. Why I bet most of your patients are proud to have chosen you.

1. Because every health care blog I read talks about workload, administrivia, the impossibility of having ‘more paperwork’ equal ‘better health for the patient.’

2. Because torte reform, in my lexicon, refers equally often to voracious attorneys and outrageous, disproportionate awards.

3. Because government is out of control – in its interference with medicine and lots of other things. Back in the 1990s we noticed that every real estate transaction had one more piece of paper than the one before it – culminating in the piece of paper the buyer was required to sign that said, in essence, ‘if anything I’ve signed on any other piece of paper turns out to be untrue or in error, I promise to fix that and sign a new document.’ It's not happening only in healthcare; and it's not because of anything health professionals have done wrong.

4. Because the government doesn’t get the difference between making ‘real improvement’ and making ‘paperwork that purports to document real improvement.’

5. Because repeatedly in my experience the primary care doctor is the one physician who sees me as a whole person and not as the specific organ of specialization … and repeatedly it has been the primary care doctor who saw the connection between symptoms in different systems and correctly diagnosed the cause.

6. Because mainstream culture (perhaps especially news organizations) has completely forgotten that nobody gets out of here alive, no matter how good their doctor is. And because the person who dies from whatever medical situation today may have been spared a more difficult death from war, personal violence, dementia or catastrophic illness.

7. Because even when you’re struggling to keep up with the technology theoretically designed to support both of us, I do know you’re doing your best – and your expertise and caring are of tremendous value to me, both medically and personally.

8. Because everyone is entitled to a bad day, even rocket scientists and brain surgeons – even you.

9. Because you are not the only one who is deathly afraid of governmental intrusion and bureaucratic malfeasance.

10. Because your patients know you care about them and appreciate how difficult it is to practice in these times.

11. Because I sure wish I could reassure both of us that disgruntled customers of every kind would all leave their guns at home.

12. Because I am so glad you came to the healing arts and professions with pure and innocent motives. Because every thing I’ve read of yours says you are the kind of doctor I wanted to be.

The Write Words said...

I so appreciate your heart-felt sentiments here Dr. I wish more physicians thought like you, or at least were not afraid to express it. The government is taking away your and my freedom. It is more than concerning. Even more frustrating, is the ridiculous circus the insurance companies seem to have doctors like you enlisted in. Not long ago, a wonderful doctor here in Southern California told me he was so fried with insurance companies regulations and mandates, that he was ready to just practice medicine apart from the insurance companies. His frustration was not just with the paper work, but the abuse of the medical profession at large. To be told by an insurance company that they will or will not cover a treatment, medication or procedure without excessive red tape, etc. is just wrong. They are not doctors. They did not put the years in preparing for this. Who are they to tell any doctor which prescription medicine to use over another? It's just WRONG!

I am so sorry you are feeling this way about your profession. It truly sounds like you entered into this field with high standards and a passion to help. How sad that the government and these insurance agencies are becoming an embarrassment to such pure and innocent motives.