Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Primary care is a story of misaligned incentives

Robert Glass, MD
Physician
January 8, 2015
Share
Tweet
Share

One of my patients got admitted this past week. As a new attending, this is still an unpleasant experience. Have I failed? Is there more I could have done to prevent this? I have to say that this particular case wasn’t shocking. The patient hadn’t been doing well lately, and I wasn’t surprised when I got the message that they were on the way to the emergency room.

Due to our electronic medical record system, I’ve been able to follow along with the hospitalization as it’s progressed. It’s been a frustrating experience to say the least. Things started out well. The hospitalist team seemed to be addressing the problem at hand. Labs were improving. Blood pressure was coming up. Then, things started to go haywire.

I read the attending note one morning that said the patient needed an expensive test to further work up their respiratory status. Unbeknownst to this attending, an entire workup for this had already been done by an outside pulmonologist. Unfortunately, our EHR had that information buried as a PDF file in the scanned section of the medical record. It would have taken quite a big of digging through dozens of pages of tucked away outside records to find that.

The expensive test had already been done by the time I discovered it, and the results were exactly the same as before. I shook my head as I looked at the screen. How can this be? We are one of the most aligned health care systems around. We have embraced health care IT and have all the latest and greatest computer systems to show for it.

Despite our health care IT investment, our systems still betray us. If interoperability were truly a pillar of health care IT, then there would be no excuse for the archaic way that health care systems exchange records. The results of the previous pulmonary workup should have been at the fingertips of my hospitalist colleague, not buried in an IT back alley. In reality, EHRs are complex systems designed to fulfill meaningful use requirements and improve billing and collections. While important, these items should not trump patient care.

Beyond EHRs, my relative absence from my patient’s hospitalization, save for logging in occasionally to check on things, stems from an incentive problem in every primary care office. While I love being the quarterback for my patients, I am rarely paid to do this. I would love to think that my presence could have greatly streamlined my patient’s hospitalization. What would it look like if the hospital team actually collaborated with me on a daily basis? What could we accomplish? How much more value could we deliver?

Instead, I sit in my office with little communication from the hospital team until the discharge summary appears in my inbox. I’ll read it through either after office hours or just before the patient comes in for their follow-up because there is no other time allotted for me to do it. All the while, I’ll still wonder if there’s a better way to do this. Is there a way that we can make our system actually reward providers working together for the good of the patient? Is that too much to expect?

Robert Glass is an internal medicine physician at MUSC Primary Care, North Charleston, SC. He can be reached on Twitter @HumorMD.

Prev

A 3-year-old taught me to chase my dreams

January 8, 2015 Kevin 0
…
Next

3 ways to use bacon as medical treatment

January 8, 2015 Kevin 3
…

Tagged as: Health IT, Hospital-Based Medicine, Hospitalist, Primary Care

Post navigation

< Previous Post
A 3-year-old taught me to chase my dreams
Next Post >
3 ways to use bacon as medical treatment

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Robert Glass, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Reflecting on DNR/DNI after being a code team leader

    Robert Glass, MD

More in Physician

  • Why being a physician mom is harder than anyone admits

    Cynthia Chen-Joea, DO, MPH
  • Removing vaccine advisers could jeopardize lives

    J. Leonard Lichtenfeld, MD
  • Why would any physician believe that the practice of medicine will become less abusive for them in the future?

    Curtis G. Graham, MD
  • The hidden war on doctors: Understanding administrative violence

    Maryna Mammoliti, MD
  • How doctors can stop frivolous lawsuits before they start

    Howard Smith, MD
  • How the 10th Apple Effect is stealing your joy in medicine

    Neil Baum, MD
  • Most Popular

  • Past Week

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Essential questions about nurse practitioner liability insurance [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
    • 9 domains that will define the future of medical education

      Harvey Castro, MD, MBA | Tech
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • What led me from nurse practitioner to medical school

      Sarah White, APRN | Education
    • Why local cardiac CT scans could save your life

      Benjamin Cohen, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 18 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Essential questions about nurse practitioner liability insurance [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
    • 9 domains that will define the future of medical education

      Harvey Castro, MD, MBA | Tech
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • What led me from nurse practitioner to medical school

      Sarah White, APRN | Education
    • Why local cardiac CT scans could save your life

      Benjamin Cohen, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Primary care is a story of misaligned incentives
18 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...