Regulations are changing the very heart of medicine

You treat a disease: you win, you lose. You treat a person, I guarantee you win – no matter the outcome.
– Patch Adams

Health care reform sounds like a great idea, in theory. Get more people the access they need. Improve the quality of health care provided. Get doctors on electronic health records so they can more easily coordinate care between specialists. I agree with these tenants wholeheartedly. The problem is not the idea of health care reform but the how if it. Regulations and red tape are changing the very heart of medicine.

For many doctors these days, medicine feels more like a job than the artful profession we signed up for. Doctors and other health care providers did not come into this to sit at a desk all day entering data. They did it to help people. The amount of hoop jumping for administrative tasks leaves little time for what really matter – patients.

Take the case of electronic health records. Not all doctors are computer savvy, and I have met more than a few who retired early rather than deal with the stress of transitioning from paper to electronic charts. For those who do start on an EHR, the costs are high and the learning curves steep. Not only do medical offices often need to purchase new hardware, but they need to pay for annual licenses to the EHR program for each user as well as tech support. A study in Health Affairs shows a five-physician practice spent on average $162,000 on hardware and software to implement an EHR and $85,500 for maintenance costs in that first year.

Costs are one thing but the change in work flow another. The Centers for Medicare & Medicaid Services requires that doctors meet criteria for meaningful use with their EHRs. While it is important to optimize use of an EHR, every health care provider must battle the nuances of the specific EHR they chose. If meaningful use criteria are not met by a certain date, those doctors will be paid less. This is forcing doctors to change how they practice medicine. Many doctors find their noses buried in screens to get their work done. For some providers, more time is spent documenting their charts than in face-to-face care.

Now add to this the issue of pay-for-performance. In some cases, doctors are paid more or less based on how well they can control a patient’s numbers — blood pressures, sugar levels, etc. How fair is it to judge a provider when those magic numbers may not be attainable, by genetics or otherwise? Or when the patient does not take their medications as prescribed? The doctor may be working as hard as any other but is being penalized despite his efforts.

The sustainable growth rate formula is another way that doctors have been demoralized. The formula aims to cut payments to doctors by significant rates every year, and though stop gap measures are put in place, Congress fails to repeal it. The threat lingers on. With decreased reimbursements, many doctors are forced to see more patients to keep their clinic doors open.

I overhear the public talk that doctors get paid too much, not acknowledging their high educational debts or the amount of time spent in training. It makes me wonder how workers in other fields would feel if pay cuts were threatened every year? In most other professions, promotions come into play, not demotions. Work harder to get paid less.

I myself had become disillusioned by the new medical regulations. I took to medical necessity compliance and utilization reviews for more than a year to learn more about the non-clinical side of medicine. Sure enough, the information I gleaned allowed me to write two books, and I will always be grateful for that. But I will always be a doctor at heart. People are what matter most, and I soon found myself back in the clinic.

What can doctors do to not get jaded in a system that is adding more walls than support?

Doctors, we have to bring it back to the patient. Patients are the reason we came into medicine, and if it isn’t, maybe this isn’t the profession for you. We have to look up from our computer screens and see the person before us. Listen to him. Listen to his concerns. Listen to his wants and needs. Learn who he is. When he asks you about his prognosis, answer him truthfully and honestly, not with the fears of litigation. When the patient calls you with questions, he is concerned for his well-being. Do not make him wait days for answers. Be charitable with your time when you can. Make him well, if not by curing him — because too often we cannot — but by treating him with dignity and respect. Offer him the healthiest life you can in the circumstances. You will be rewarded.

It is not always an easy feat to give of yourself when you have so many other tasks to complete or when the patient does not treat you with the same kindness. But when we lose sight of why we are doctors, we lose sight of everything. Make it worth your while and their while. Maybe that means changing how many patients you see, changing your work hours, or making changes to your practice workflow. The how is for you to decide. What matters is that you find your heart in medicine again.

The movie Patch Adams came out in 1998 before I entered medical school. Hunter Doherty “Patch” Adams knew what it meant to be a doctor. He kept the doctor-patient relationship alive even in the thick of devastating illness. When he founded the Gesundheit! Institute in 1971, he had it right, and I hope America can get it right too. Not that doctors have to do open an institute like Patch did, but we should always remember what medicine is really about. People.