Blog | Friday, May 9, 2014

Things that frustrate physicians and harm patients


Ask any practicing physician, even we academics who practice part-time, what their frustrations are with current practice, and be prepared for a soliloquy. We all have opinions, and mostly we name the same frustrations. The current The Atlantic has a brilliant article, Doctors and Tech: Who Serves Whom?

This piece starts with a classic observation: If you want to discourage a worker, subject them to policies and procedures that don’t make sense. This principle was first described by Frederick Herzberg, an American psychologist who developed one of the most widely studied theories of workplace motivation. Unfortunately, Herzberg’s principle is being widely applied today in medicine. Changes in health care payment systems, the use of information technology, and the doctor-patient relationship have left many doctors deeply discouraged.

We physicians are rarely shrinking violets. We see senseless policies and procedures and shout at the rooftops (or write blogs). We complain loudly. But it seems like no one is listening. The younger Weygandt believes that contemporary medicine has allowed too many intermediaries—financing, technology, and the way practices are structured—to come between patients and doctors. Too much time is focused on generating revenue rather than quality. Too many technological systems are built in ways that make sense to computer engineers but not to doctors. And too much time is spent pointing and clicking rather than capturing the essence of a patient’s story.

Can we have an AMEN?

Our complaints are not just self-serving, rather they have great impact on patients. Patients want to connect with physicians, be looked in the eye, and get information delivered in a humane way. They do not want to look at us typing and pointing and clicking.

Our billing rules make no sense, and the proliferation of coding seminars disgusts me. Why should we need seminars to learn to write obtuse, uninformative notes just to meet billing requirements. And those requirements drive electronic records.

What happened to notes about the problems, our assessments and our plans? What does Larry Weed think of this nonsense? Everyone involved in contemporary health care—patients, doctors, nurses, hospital administrators, payers, and politicians—needs to recognize the importance of preserving and promoting medical professionalism. Good medical care is an art as well as a science, and the professionalism of doctors is at its core. “Doctors should be encouraged to think first not of their own incomes but the needs of their patients, and that means designing systems that keep the patient front and center.”

Current billing requirements, current electronic record keeping, and current performance rules frustrate physicians and hamper the doctor patient relationship. We must demand better from CMS, insurance companies and those who define meaningful use. This is about patient care, and the suits seem clueless.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.