Dropping The Ball?

I love Juggling. I started when I was a little kid. Originally my brother learned from reading a book. But I had to be better than him. I taught myself. I started with one ball and tossed it back and forth from hand to hand. I did this for weeks till I had mastered the skill. I could do it with my eyes closed.

Next I added a second ball. Two balls are a little more tricky. The juggler's concentration is split. The chief process is still similar. Throw the ball up with one hand and catch with the other; except now two hands are both engaged at the same time.

Months later, I was ready to try three, and then four. The trick to juggling is to be able to give the appropriate amount of attention to each ball at the right time, while being generally aware of all the rest. It is a dance performed by the hands, but mastered by the eyes. The more balls one has in the air, the quicker and more intense one must focus on each ball, and then move on. Once concentration is lost, everything tumbles to the ground.

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Medicine is a lot like juggling. The doctor must have razor sharp focus on each patient at times, but also be aware of thousands of others in the background. It's a balancing act. One in which we struggle to keep all balls up in the air at one time. This is becoming more difficult. Even in the last year, the number of distractions facing the lowly generalist are increasing.

Five years ago, the paperwork and hassles were less. There was no such thing as face to face encounter forms to fill out, or med reconciliation forms. Pre authorization was slightly less rampant. Electronical medical records are dutifully adding to time spent on charting. While all of these may have some beneficial impacts (emphasis on "may"), there are consequences also.

The struggling primary care doctor can no longer keep up with all the balls in the air. Attention and focus are being nudged away by paperwork. One would argue that maybe the physician should start to focus on fewer balls. But with decreasing reimbursements and increasing need in the community, that's just not likely to happen.

So the question is no longer whether physicians are dropping the ball,

it's why?