I guess what is so utterly frustrating is that the guys up there don’t see what is going on down here. The march of health care reform continues with little realization of what it feels like to be one of the tiny peon foot soldiers on the ground. We are not deaf. We hear the politicians and policy wonks. We read as non-clinician “doctors,” ivory towered administrators, and the business and public health degrees tell us how we are being obstinate when we balk at the grand reform being shoved down our throats.

If those darn doctors would just step in line!

Those of us providing care on a daily basis have an alternate perspective. We see the trees from the forest in a very different manner. While the view from a thousand feet may be rosy, on the ground the various and myriad pot holes threaten to cause a rent in the great superhighway of our care giving universe. We see the beginnings of destruction, gridlock.

Are we dumbing down American medicine?

The message and the finger pointing couldn’t be clearer. Physicians are being blamed for overspending, overtreating, and overutilizing. The doctor’s pen has been given mythical status and the great call to silence it echoes throughout the tenor of health care legislation. Yet, there is no acknowledgement that physicians are sandwiched between the needs of the individual and the needs of the community, which are often at odds. Emotionally attached, afraid of legal retribution, and unfaultingly aware of the oaths we took in medical school, we are left to look into each families eyes and proclaim our decisions. No policy wonk has ever been faced with such responsibility.

There is a not so subtle attempt dumb down American medicine. The Affordable Care Act aims to promote less rigorous programs of study to replace those of us who are reticent to fall in line. Alternative medicine is being given in roads to reimbursement at the exact same level as physicians even though such fields lack the evidence based outcomes that are being so thoroughly evaluated in the doctors’ clinical care.

Nurse practitioners and physician assistants are being championed as the next best thing even though many are graduating with slim clinical experience. Residency programs are few and far between. Pharmacy based clinics staffed with new graduates are taking on the herculean task of managing chronic illness with a fraction of the time and commitment.

Are physicians automatons?

There is a pervasive push to destroy deep and independent thinking. The call for health care technology not only attempts to automate our work processes, but to replace our thoughts. People can no longer be trusted with such important tasks. We are trying to graduate from meaningful use to “meaningful cognition.” But, to date, no machine or clinical guideline has ever been able to place a hand on the shoulder of a suffering patient. Only a person can love and care for another person. Destroying the art of medicine will only lead down a false path of buffed numbers but sick and despondent patients.

We heal with our hearts, our minds, and our souls.

Why take the soul out of medicine?

Is data the new work product?

A doctor’s job is now more about filling out forms and clicking clicks than face to face patient evaluation. Even in the last few years, the amount of paperwork has expanded rapidly. Physicians in training spend radically more time in front of computer screens than in patient rooms.

The confusion stems from the idea that good health care is about documentation and less so healing. Meaningful use never saved a life. Medicine reconciliation means nothing if someone hasn’t properly diagnosed and prescribed the right medications in the first place. Good care giving takes slow, deep, and unlabored thinking.

Your average doctor has no time for this anymore. They are too busy doing paperwork.

Here on the ground, we are seeing great decline

Our patients are suffering. Physicians are bowing out or becoming concierge. The hospital is now the de facto outpatient clinic: admit and evaluate.

Over and over again, sub-par medicine is now the rule. While we physicians complain, in the end we will be just fine.

Our patients, however, are the ones paying the ultimate price.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.