Monday, February 20, 2012

Provide "Health Care"

I felt the rage rising in my throat and the warm tingling sensation at the back of my neck. The poor woman feebly offered the paper with her hand shaking. I tried to withhold the painful grimace that had started in my brain but not yet made it's way to my face. The phone was ringing, my next two appointments were waiting in their rooms, and I had lost patience.

It wasn't her fault. She was only following directions. But the licensing committee wanted clarification of a few issues filled out on the previous form and "discovered" in the medical record. For instance, when I used the diagnosis of "dizziness and giddiness" back in 2005, what had I meant. The sweat poured down my brow as I hunched over the EMR and traced back to the visit. As I suspected, she had momentary dizziness in association with an upper respiratory infection.

And there was a reference to her physical in 2010. Had I worked up the cervical lymphadenopathy? Again my irritation was growing as I found the note. Self limited, due to a mild case of Strep. It had resolved long ago.

I fiddled with the EMR in an attempt to compose a letter that would be printed and mailed to the appropriate agency. I glanced up at the clock. I was running fifteen minutes late.

I wanted so badly not to be angry.

But as I typed out the useless document, all I could think about was the countless hours spent on such idiotic tasks. How many "face to face" encounter forms had I filled out in the last week? How many preauthoriztions were due on patients who hadn't even changed meds?


As the years pass, my administrative and clerical responsibilities are growing. More energy is spent in the exam room checking boxes and filling out forms. Less time is allotted for the evaluation and treatment of acute and chronic illness.

In a way, I've been spoiled. As a physician, I was taught that I was too important to waste time on such menial tasks. I handed the paper to someone else, and moved on to clinical work. That is what I was trained to do.

Today, however, there is no longer any one to do the paperwork for us. Physicians are adapting by learning shortcuts. Instead of toiling longer hours, they are working "smarter". Which means time spent on clerical tasks is stolen away from patient care.

Are you wondering where your doctor is?

He's probably locked up in a small room with a pile of papers wending it's way to the ceiling.

He is doing exactly what he was ordered to do:

provide "health care".

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