DOCTORS’ LOUNGE
DOCTORS’ LOUNGE
MEDICAL TITANIC
Larry Griffin, MD
The Titanic was sunk by a massive iceberg unseen until too late to avoid. Thousands of lives were lost and the world mourned the event as a massive disaster. We are now facing the equivalent of tens of thousands of Titanic-sized disasters on a daily basis as a result of the rapid deterioration of the practice of medicine in this country. The difference is that the Titanic disaster was in every newspaper and on the tip of everyone’ s tongue. With the issue in medical practice, however, such disasters individually are rarely even recognized, and if so, only by those most closely aligned to them, assuming they are singular events, not the tip of a medical iceberg.
I don’ t believe anyone goes to medical school to be a mediocre physician. We are, by our very nature competitive, ambitious, energetic, enthusiastic, inquisitive men and women who thrive on being the best at what we do. Without that competitive streak within us, none of us would have gotten into medical school in the first place, much less successfully completed it and the requisite training which follows.
Our schedules have always been demanding, because we made them so. After all, professions are what we live, not what we do. Our profession, more than most, defines us, not solely, but certainly in large part. We willingly make the sacrifices we do in order to best serve our patients and our profession- to make our community a better place one patient at a time.
I have witnessed, however, as have many of you, the massive changes in the practice of medicine over the past 10-20 years. Corporate practice, RVU counts, the increased“ efficiency” of medical practice, replacing much of what we trained to do with mundane tasks which could be done by those with much lesser skills and training and education. At the same time, however, those with much less training, education and without the benefit of a medical degree are attempting to replace us as physicians under the guise of expanded access to care.
Yes, their results overall are about as good as the care provided by a physician( as they like to point out), but that is simply because most minor ailments are self-limited anyway( which is why charlatans, witch-doctors, and snake oil salesmen of all ilk have been so successful through the ages), and no matter how little you know or do, most of their patients will have a good outcome. That becomes more complicated, however, when those with incomplete education or training have the ability to order tests or procedures which, in addition to being expensively unnecessary, carry a risk of complication or injury, as well as additional strain on an already overburdened family’ s medical budget. It’ s only those who really need our full education, training, experience and dedication who truly benefit from seeing a physician. In those relatively less common encounters in which that extra bit of knowledge, experience and insight make the difference in distinguishing a serious illness or condition from its minor, self-limited doppelganger, the mid-level practitioner is insufficient and a danger to patients.
Now, increasing pressure on physicians to produce more and more for less and less reimbursement( and therefore greater profit to the“ not-for profit” institutions which hire them) results in less time to really evaluate patients. Think about the myriad of possible conditions they represent, and truly give insightful thought to the best approach to their individual problems. Add to this the additional work required( as well as the difficulty in finding the meaningful and important information) in the electronic medical record systems we now all have to endure, and the result is too little time to adequately care for the patients in front of us.
Fortunately, since most of those conditions are not life-threatening and many will resolve on their own, most patients have acceptable results. In corporate medicine, the PR types of concerns- whether parking was validated, or they had to wait in an uncomfortable chair, or read an outdated magazine while waiting, or a myriad of other Press-Gainey issues having nothing at all to do with the actual quality of care delivered- can become a major issue for the physician being evaluated.
Unfortunately, however, patients do suffer at times as a result of this system, either in terms of missing a diagnosis, rushing through a biopsy, not spending adequate time reading or reacting to an imaging report and the subtle wording within it which, had attention been paid, would have alerted the physician with time to absorb it to a malignancy which might otherwise be missed.
I have seen this occur, as have many of you, in the past. Now, however, it seems to be much more common. Ultrasound reports are misinterpreted and not integrated into the overall care plan of a patient. Lab reports are formatted differently, so a seriously abnormal result gets missed because of the new nuances within them. Since there is no
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