Dear patient:
I am writing to inform you of some recent changes to my practice. These changes have been implemented to improve the quality of your care.
I will no longer be able to see you for a 20-minute or 40-minute appointment. These will instead be shortened to a 10-minute or 20 minute-appointment based on your stated needs. For example, if you just need a physical exam, we will do this in 20 minutes. I am told easier things should take more time.
However, if you would like to talk to me about the fact that you have lost 30 pounds these last three months, have a past history of cancer and you’re not sure if you want chemotherapy again, this should take only 10 minutes because your concern is just “weight loss.” I am not allowed to make special accommodations for your concerns; if I do, I am giving away care and contributing to the current health care crisis. I am also not to consider the fact that you traveled 60 minutes, took unpaid time off from your job, or spent half your day arranging for childcare to see me.
Because of these schedule enhancements, I will likely rush through our time together and gloss over details. I will need to spend my time multitasking with the computer as I can only prove the quality of my care by checking boxes. Do not worry; studies have shown that physicians can’t multitask any better than anyone else and I will likely miss important details. In order to make up for that fact, I will order a bunch of unnecessary tests so I don’t miss anything.
Yes, I could probably figure out you don’t need half of them if we spent more time together, but I am told just talking to patients is poorly compensated care and I need to be mindful of this. I will rush out of the door onto my next patient who has been waiting over 30 minutes to see me to do the same to them.
You may call back because the problem we addressed has not resolved. Instead of thinking about your issue further, I will refer you on to a specialist because I am too exhausted to think. This is a much better use of resources, you see, because the specialist is trained to deal with very complicated and specific diseases. It is much better for them to see something that is straightforward and not use their training appropriately because that would require thinking and I have already shown you that thinking does not pay the bills.
You will see the very nice specialist I send you to and will feel reassured that they will know a lot about your health already because we have electronic records these days. However, I will forget to request to have your records sent over with your referral because I spent five hours on more important tasks such as typing, checking boxes and electronically filing paperwork; I am told only someone with 7 to 10 years of post collegiate training has the capability to do this. The specialist will not be able to see all your records because our systems do not communicate, but will receive something we call a problem list. However, she will miss part of your health history because it is buried in a list of 50 other very important diagnoses such as “pimple,” “cold,” or “administered vaccine.”
That detail will be important. You will not get better and will go to the ED. The ED physician will decide that he needs to hospitalize you after talking to you for two minutes, most of which he interrupts you to ask a question. Do not worry; the ED physician does this because he needs to see 50 patients in one hour. This is the patient-centered care you see advertised on billboards as 10 minute or less wait times.
You will have the opportunity to meet at least three more doctors while you are in the hospital. Do not expect them to be attentive or explain anything; they have been working for the last ten days in a row and can’t remember the details of your problem. When they write down the medications you should take when you go home, they will forget to include your water pill because they got 15 phone calls in 5 minutes.
You will likely gain 10 pounds because you didn’t restart your water pill when you get home. Do not worry; we are more efficient at providing quality care than ever before. There is now a 5-minute appointment awaiting you.
Susan Hecker is a physician.
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