Blog | Thursday, May 18, 2017

A great battle is on for the heart and soul of medicine

Health care has undergone innumerable changes over the last decade, and the pace of change only appears to be accelerating. At the crux of most of the changes we've seen, is the central problem that the cost of our health care system is unsustainable, and that we as a nation need to put the brakes on it. The costs to individual patients are also unacceptably high. Unfortunately, the prevailing philosophy has been to increase regulations, add ever more layers of expensive bureaucracy, and pile on more non-clinical administrators. No reasonable person would argue against a sector as large and vital as health care, not having a degree of oversight. But at the same time, if the aim was to curb spending—is there any evidence that what we're done is working?

Statistics suggest that America's physicians are facing an epidemic of burnout and job dissatisfaction. This has less to do with the nature of the job itself, but with the way the practice of medicine has changed, and become unrecognizable from what it once was. The need to follow regulations has heaped a massive amount of non-clinical duties onto physicians of all specialties. An ever-shrinking amount of time is spent with patients, and an ever-increasing amount spent staring at a computer screen—typing away furiously and clicking boxes to fulfill these regulatory requirements. It used to be X amount of time with the patient, and then a fraction of the time writing a quick note and placing orders. Now, it's X amount of time rushed with a patient and then 5X time spent on documenting what happened on a computer. In no other field would you spend up to 5 times the amount of time documenting what happened, versus actually doing it. Compounding this is the fact that the available information technology solutions have been rushed out, unevolved, and are poorly reconciled with frontline clinical workflow. For this reason, IT in its current format has done more damage to the doctor-patient relationship than any other one single thing.

Most doctors carry what's known as the “altruism gene.” Being a physician may be relatively well-compensated compared to the average salary, but the vast majority of doctors went to medical school because they have a genuine and sincere desire to help people. The less of their day that's actually spent doing this, the more prone they will be to job dissatisfaction. Doctors are extremely hard-working, intelligent, and most of us desire to stay true to the ideals of good medicine. We are kind souls at heart who want to do the best for our patients. The practice of medicine is still very much an art, and a very special job.

The crazy thing is that the regulatory requirements that have been heaped on doctors, have been done so by administrators who themselves would love a caring and thorough doctor for themselves and their family. Yet we are caught in a vicious circle where it seems like every new mandate and policy, takes doctors further away from our patients and makes practicing good medicine more difficult.

Currently, a great battle is on for the heart and soul of medicine. It's my hope that doctors stand up for our profession and remember why they went to medical school, pushing for the pendulum to swing back to where it should be. Aside from it being what doctors want—our patients are desperately asking for this too.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.