It’s not that Physicians do not want to
spend time with Patients…Physicians would like to spend time with those they
care for. Problem is the “Bean Counters” have taken control of medicine, and
force physicians to treat patients as a source of revenue! That’s just the half
of it…the other half are office managers that are assigned (by the
Hospital/Health system) to manage the office’s operation. Most (not all…I know
several good ones) of these managers are incompetent (and are only taking
orders from the Bean Counters & HR)!
August 23, 2014 | 3:00pm
NY POST
Dr.
Sandeep Jauhar is mad as hell.
American
health care is in upheaval. On one side, overhead and malpractice insurance
costs keep increasing, while salaries stagnate. On the other, patients believe
that expensive drugs are better, more people are on government-run insurance
that pays less, while private insurance fights every claim.
Now
doctors spend most of their time trying to game the system, requiring endless
paperwork, protracted bureaucratic battles and “treadmill medicine,” seeing as
many patients as possible in as little time. This problem will only intensify
as millions join the ranks of the insured under the Affordable Care Act.
In this
self-perpetuating cycle, doctors spend most of their time as businessmen — and
care suffers.
It’s no
wonder then that doctors no longer enjoy their jobs, explains Jauhar, director
of the Heart Failure Program at Long Island Jewish Medical Center and author of
“Doctored: The Disillusionment of an American Physician” (Farrar, Straus and
Giroux), out now.
“This
book is meant to be like the scene in ‘Network’ when [Howard Beale] opens the
window and yells, ‘We’re not going to take it anymore,’ ” Jauhar says in an
interview with The Post.
“I see
an emotional emptiness created by the relentless consideration of money. Most
of us went into medicine for intellectual stimulation or the desire to develop
relationships with patients, not to maximize income,” he writes.
In a
2008 study of 12,000 physicians, only 6% described their morale as positive.
Even insurance claim clerks polled in a different study were happier.
As
managed care has grown (by the 2000s, 95% of insured workers were in some kind
of managed care plans), so has physicians’ discontent. In 1973, fewer than 15%
of physicians reported any doubts about career choices. Today nearly 40% say
that they would not choose to enter the medical profession if given the opportunity
to do it all over.
If
things continue as they are, the US can expect a shortage of 150,000 doctors by
2025, according to the American Medical College. Jauhar says that doctors on
the online community SERMO are threatening to leave the country or scrap their
private practices.
The
serious downside here is obvious: Unhappy doctors make for unhappier patients.
“The
physician-patient relationship is the worst it ever was,” he says.
To
hammer in this point, Jauhar quotes facts from the Commonwealth Fund: The US
ranks 45th in life expectancy (“behind Bosnia and Jordan,” he adds) and
compared to other developed countries near last in infant mortality and
health-care quality, access and efficiency. We also have fewer physicians and
hospital beds than average.
This
“mid-life crisis in medicine” is reflected in Jauhar’s own writing.
Readers
can follow his skepticism in “Intern,” his first book about his internship year
at New York Presybterian, harden into disillusionment in “Doctored,” which
chronicles his time at LIJ as he enters his middle age (he’s now 44).
“Doctored”
opens with: “When I look at my career in midlife, I realize that in many ways I
have become the kind of doctor I never thought I’d be: impatient, occasionally
indifferent, at times dismissive or paternalistic.”
This
“kind of doctor,” once so idealistic, now takes morally ambiguous speaking gigs
with pharmaceutical companies and side-jobs at “sketchy” cardiologist private
practices who push for expensive and often unnecessary tests for the reimbursements.
And
this is where the book gets really bleak. Doctors — like his own brother, also
a cardiologist — refer to patients as “commodities.” One physician at LIJ
admitted that “sometimes you have to drag out” a hospital stay for a patient if
you want to get paid.
He
writes about one of his patients, a 50-something man who complained of
shortness of breath. Fourteen doctors, 12 procedures, and hundreds of thousands
of dollars later, he was released with minimal improvement.
This is
a problem not only of milking income, which of course happens, but because
doctors just don’t have the time to do their jobs. Primary care physicians
(doctors who Jauhar believes are most unhappy) spend an average of eight to 10
minutes per patient.
It’s a
self-fulfilling prophecy. With less time for each patient—studies show (no
surprise here) that rushed doctors listen less — relying on expensive tests,
which don’t necessarily lead to more accurate diagnoses. Med school advises
doctors-in-training that you should be able to diagnose 80% of cases with a
health history and an exam alone.
No
further tests required.
But in
this exam on-the-run environment, doctors are more likely to practice
“defensive medicine,” or “cover your ass” medicine — costing us about $750
billion a year (of the $3.8 trillion we spend a year) in wasteful procedures
that lead nowhere.
“After so many years in medicine, I am convinced of one thing: The vast
majority of doctors aren’t bad. It is the system that makes us bad, makes us
make mistakes,” he writes. “There is a palpable sense of grieving. The job for
many has become just that — a job.”
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