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

Doctors are playing a very difficult game of changing rules

Emily Gibson, MD
Physician
August 12, 2015
Share
Tweet
Share

shutterstock_161298866

“The chief difficulty Alice found at first was in managing her flamingo: She succeeded in getting its body tucked away, comfortably enough, under her arm, with its legs hanging down, but generally, just as she had got its neck nicely straightened out, and was going to give the hedgehog a blow with its head, it would twist itself round and look up in her face, with such a puzzled expression that she could not help bursting out laughing: and when she had got its head down, and was going to begin again, it was very provoking to find that the hedgehog had unrolled itself, and was in the act of crawling away … Alice soon came to the conclusion that it was a very difficult game indeed.”
– Lewis Carroll from Alice in Wonderland

Navigating the U.S. health care system these days reminds me of Alice’s dreamscape game of Wonderland croquet.  A physician is given a flamingo mallet and a hedgehog ball and ordered — by the Queen at the risk of having one’s head lopped off — to go play, but the mallet won’t cooperate and the ball keeps unrolling itself and crawling away.  Just like any day in a medical clinic, a doctor’s time is spent trying to manage their flamingo and the patient gets tired of waiting,  so gets up and leaves.  At least Alice gets a good giggle out of it, but the reality in health care causes more tears than laughter.   We are playing a very difficult game of changing rules and equipment.

The flamingo in the doctor’s hands could represent the increasingly time-consuming requirement now to search over 68,000 ICD-10 diagnosis codes rather than the previous 14,000 ICD-9 codes.  Or the requirement to search for a 10 digit NDC number for any prescription medicine sent electronically to a pharmacy.  Or the meaningful use criteria that regulate mandatory data collection and reportage on patients to the Federal Government in order to receive full payment for Medicare or Medicaid billings.  Or the newly updated HIPAA and HITECH electronic security requirements to ensure privacy.  Or the obligations to the new accountable care organization that your employer has joined.  Or the maintenance of certification hoops to jump through in order to continue to practice medicine.   The exasperated and uncooperative “managed” flamingo keeps curling itself around and looking at us with a puzzled expression: Just what is it you were supposed to be trained to do?  Is there actually a patient to pay attention to in all this morass of mandates?

And the poor hapless hedgehog patient is just rolled up in a ball waiting for the blow that never comes, for something, anything that might look like health care is about to happen.  Instead there are unread notices of patient privacy to sign, as well as releases to share medical information to sign, agreements to pay today’s co-pay and tomorrow’s deductible and whatever is left unpaid by Affordable Care Act insurance, passwords to choose for patient portals, insurance portals, lab portals and healthcare.gov.  It might be easier and less painful to just crawl away and hide from that bumbling physician who can’t seem to get her act together.

I wish I were laughing, but I’m not.  As both physician and patient, it’s getting harder and harder to play the game that is no game at all.  The threat of losing credentialing in an insurance plan, or getting poor ratings on anonymous online physician grading sites, or being inexplicably dropped from a provider list, or too unproductive to remain in an employer medical group, or losing/forgoing board certification is like a professional beheading.  We keep trying to juggle the flamingo motivated by those threats, all the while ineptly managing the managed care system, and hoping the patient won’t walk away out of sheer frustration.

It’s hard to remember why I’m in the game at all. I think, at least I hope,  I wanted to take care of people, heal their illnesses and help them cope with life if they can’t be healed.  I wanted to provide compassionate care.

It is enough to make a doctor cry.  At least we can meet our patients at the Kleenex box and compare notes, and maybe, just maybe, we’ll find enough common ground to even share a laugh or two.

Emily Gibson is a family physician who blogs at Barnstorming.

Image credit: Shutterstock.com

Prev

Cerner beats Epic in the DoD sweepstakes. What does that mean for the rest of us?

August 12, 2015 Kevin 0
…
Next

This is why the humanities are important in medicine

August 12, 2015 Kevin 2
…

Tagged as: Primary Care

Post navigation

< Previous Post
Cerner beats Epic in the DoD sweepstakes. What does that mean for the rest of us?
Next Post >
This is why the humanities are important in medicine

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Emily Gibson, MD

  • This family physician is deeply disappointed in maintenance of certification

    Emily Gibson, MD
  • Advice physicians should follow. But don’t.

    Emily Gibson, MD
  • I’m grateful to be open for business. This doctor is in.

    Emily Gibson, MD

Related Posts

  • Physicians who don’t play the social media game may be left behind

    Xrayvsn, MD
  • Why is it so difficult for Americans to make doctors’ appointments?

    Peter Ubel, MD
  • She sees difficult patients, but is a difficult patient herself

    Kristin Puhl, MD
  • Why do doctors who hate being doctors still practice?

    Kristin Puhl, MD
  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • Why medical school is like playing defense

    Jamie Katuna

More in Physician

  • The weaponization of rules: How regulatory overreach puts physicians and health care at risk

    Kayvan Haddadan, MD
  • Ethical dilemmas in using unclaimed bodies for medical research

    M. Bennet Broner, PhD
  • The Nova Oath: a physician’s pledge to courageous and ethical care

    Kenneth Ro, MD
  • True stories of doctors reclaiming their humanity in a system that challenges it

    Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO
  • Why wanting more from your medical career is a sign of strength

    Maureen Gibbons, MD
  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • Most Popular

  • Past Week

    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
  • Past 6 Months

    • 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
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
  • Recent Posts

    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • How a family’s strength led to a successful kidney transplant

      C. Nicole Swiner, MD | Conditions
    • The food-drug interaction risks your doctor may be missing

      Frank Jumbe | Meds
    • Beyond the TikTok hype: Rebuilding trust in evidence-based weight loss medicine

      Sarah White, APRN | Conditions
    • The weaponization of rules: How regulatory overreach puts physicians and health care at risk

      Kayvan Haddadan, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast

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 88 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

    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
  • Past 6 Months

    • 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
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
  • Recent Posts

    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • How a family’s strength led to a successful kidney transplant

      C. Nicole Swiner, MD | Conditions
    • The food-drug interaction risks your doctor may be missing

      Frank Jumbe | Meds
    • Beyond the TikTok hype: Rebuilding trust in evidence-based weight loss medicine

      Sarah White, APRN | Conditions
    • The weaponization of rules: How regulatory overreach puts physicians and health care at risk

      Kayvan Haddadan, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast

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

Doctors are playing a very difficult game of changing rules
88 comments

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

Loading Comments...