Several interesting facts crossed my computer screen recently. The first was a Tweet by American Medical News that the first CT scan was performed on August 25th 1973. The second focused on the large number of practicing physicians who suffer from burnout, and the third was an article, which cited a talk given by Vinod Khosia in which he is quoted as saying “80 percent of doctors could be replaced by machines.”
I believe that technology has been a major factor in improving our capability to diagnose and treat our patients. In terms of physician satisfaction, has technology been a net positive or negative? As one scans responses of physicians commenting on electronic medical records, telemedicine and social media it appears many believe they are the enemy rather than an ally.
Clinical practice is hard, demanding, stressful, and it has changed significantly over the past 40 years. As a reminder, in 1966 there were 5 antibiotics, no CT scans, MRI’s or ultrasound machines. ICU’s and coronary care units were not routinely found in many hospitals. People with heart attacks were hospitalized for 18 days and one of the most common surgical procedures was a vagatomy and pyloroplasty for peptic ulcer disease that is now treated with over the counter medication. Insurance companies did not cover routine outpatient care, most physicians were in solo practice and almost nobody thought doctors were over paid. Nobody questioned the quality of care or its cost.
Fast-forward 40 years — there are now at least 11 classes of antibiotics with multiple drugs in each class. There are anti-viral and antifungal drugs. Heart attack patients may go home in less than three days. The average length of stay for a patient in many hospitals is less than 4 days. Much elective surgery is admitted and discharged in less than a day. As a means of improving quality, efficiency and cost many hospitals have begun hiring physicians and with the more Accountable Care Organizations (ACO) it is possible that the solo practitioner will become an endangered species.
Just this year nine subspecialty boards representing 374,000 physicians published a document recommending 45 tests that should not be done on a routine basis. Last year there was a furor over the frequency of mammograms and pap smears as well as PSA test for men. Many of our assumptions and beliefs about what is necessary are changing.
Our healthcare delivery system is broken. Everyone complains about the cost of care. The quality of care is being questioned and doctors and hospitals are now subject to a myriad of report cards.
Doctors complain about paper work, computers, insurance companies, to little time to spend with each patient or patients who are demanding and rarely listen to their advice. Patients complain about disinterested or uncaring physicians, insurance company regulations, poor service or quality and lack of communication. Is it any wonder that physicians might feel burnt out and under siege?
To address the problems that plague our healthcare delivery system and improve burnout physicians will need to embrace a different kind of change. During the 20th century change came in the form of new medications, new tools for diagnosis, (MRIs, CT scans, ultrasounds) and new machinery (ventilators, heart bypass, dialysis and robots for surgery). All of these changes required the active involvement of the physician to either write the prescription order the test or perform the procedure.
In his recent book “The Creative Destruction of Medicine” Eric Topol talks about the timing of the “big six major digital advances of the last 40 years, (cell phone, personal computer, Internet, digital devices, DNA sequencing and social networks) that have set up the great inflection of medicine.” These advances have changed the landscape with regard to the doctor patient relationship and the potential interactions that can occur.
According to the Centers for Disease Control and Prevention, 75 percent of our healthcare expenditures go for the management of chronic care. Just as DNA sequencing will allow us to customize treatment so must we strategically think of alternative modes of patient management to get away from the “routine” doctor visit? Can we change reimbursement models so physicians or others can be paid to utilize new means of communication and management? Accountable Care Organizations are in their early stage of development but I firmly believe physicians willing to aggressively recommend home monitoring devices, disease specific social networking sites, alternative means of communication including secure e-mail and telemedicine can go a long way toward improving the quality of care for the patient and the physicians quality of life
Medicine is challenging ever changing and dynamic. In my experience many physicians enter practice and assume they will do the same thing for their entire career. No wonder there is burnout. Physicians need to embrace change and get on with the “creative destruction of medicine.”
Eugene Spiritus is President and Chief Medical Officer of OMyMeds!
