I read and listen to much fiction.  While listening to a fantasy novel, one character verbalizes a most important concept.  Every action has consequences.  Those consequences are both expected and unexpected.  We might predict some unexpected consequences, if we only spend some time to think through the likely impact of that action.

Bureaucrats and politicians have imposed a series of administrative burdens on physicians and patients.  We use EHRs that work slowly and non-intuitively.  We are forced to write notes that do not make medical sense, lead to inferior communication and emphasize all the work components of a good note.  Physicians have to fill out forms for a variety of equipment and make calls to get permission to order many tests.

Office overhead increases because of these burdens.  Patient communication suffers because too many physicians stare at computer screens.  Physicians do not get paid for talking on the phone, texting or emailing, yet patients often prefer these communication options.

But we must remain optimistic.  For years, we have heard that the train has left the station.  I personally hate that phrase, because I refuse to become defeatist.  Why do I remain optimistic?

The MOC debate. ABIM has made many improvements to the process, and continues to listen to the community.  Many commenters suggested that ABIM would not adapt, and yet they have.

The recent plans to end meaningful use.  Organized medicine and many thought influencers decried MU2 — and the bureaucracy listened.

Medicare has removed several poorly designed performance measures. The 4-hour pneumonia rule is the best example.  Data speak, and they do make changes. We have an opportunity to influence which performance measures insurers use to evaluate us.

Readers can give other examples.  We can influence the rules that seem to govern our lives.  We must never accept rules that harm patients.  We should not give up, but rather speak out when rules interfere with good medicine.

To abdicate this responsibility goes against our profession and our patients.  We really must shout loudly when the emperor has no clothes.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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