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

The golden era of medicine is never coming back

Matthew Hahn, MD
Policy
June 14, 2017
Share
Tweet
Share

An excerpt from Distracted: How Regulations Are Destroying the Practice of Medicine and Preventing True Health-Care Reform.

If you want to learn what is wrong with the American health care system, just follow any doctor for just a short time. It will soon become obvious. The following common scenario should make things clear.

The patient is taken to the exam room and the doctor attempts to pull up their medical record on a computer in the corner. But because of an Internet slowdown, there is a substantial delay until the record comes up. To fill the awkward void created by these wait times, the doctor and the patient chit-chat about how bad things are in the world, especially in health care.

When the patient’s record is finally displayed, the doctor has to open and close multiple screens just to view basic medical information, which slows things down even further. It is also distracting, especially as the doctor attempts simultaneously to interact with the patient. This interaction is important because it allows the doctor to pick up important clues to what is wrong with the patient, but also because after the appointment, the patient will be filling out a government-mandated satisfaction survey that partly determines how much the doctor gets paid. Not surprisingly, staring incessantly at the computer screen rather than making eye contact with the patient often results in lower satisfaction scores.

While the patient discusses their medical history, the doctor’s mind wanders, as it often tends to, to the incredibly complicated, but government-mandated, formula used to calculate how much should be charged for the appointment. As required, the doctor tries to keep count of how many problems the patient complains about, the number of questions that were discussed in relation to each of those problems, and even the number of body systems that were reviewed in each case. As the formula specifies, the more that is discussed, the more that can be charged for the appointment. The same goes for the physical exam—the more body parts examined, the more that can be charged, so the doctor tries to keep count of that, as well. Sometimes during computer slowdowns, the doctor fantasizes about a patient with an extra arm and an extra leg, and wonders how much she could charge for that.

The doctor appropriately surmises that some testing would be useful. But the patient says he would rather hold off on any testing. He has a high-deductible insurance policy, which means that he would have to pay for any tests out of pocket. Both the patient and the doctor again take a few moments to complain bitterly about all of this. This extra time complaining has become such a regular part of many appointments that the doctor has even daydreamed about a system where she could bill for complaining. In her dream, she gets rich quickly and then retires!

When they both finish complaining, the doctor also remembers that Medicare is now monitoring how many tests and treatments she orders and comparing the cost of her medical care to that of other doctors. Beginning in 2019, there will be financial penalties if her care exceeds the average, one of the horrors contained in the new government payment reform plan, the Medicare Access and CHIP Reauthorization Act (known better by its abbreviation, MACRA). She doesn’t want to be penalized, so, the doctor thinks, to hell with clinical relevance and the best interests of the patient. She is not ordering any testing.

Since the doctor won’t have the benefit of any tests to confirm her suspicions, she just makes her best guess at the diagnosis that is most likely. But she also takes the time to explain that she just might be missing the far more deadly (though somewhat less likely) diagnosis she might have found had she been able to get any testing. This understandably upsets the patient, who requests some Valium because he is so distressed. With the threat of a negative patient satisfaction score looming over her head, the doctor gives him the Valium.

The doctor also prescribes a medicine based on her test-free diagnostic guess. She sends the prescription, which is a commonly used generic medication, to the patient’s pharmacy, but then receives a call from them to say that this medication is no longer available unless she first obtains prior authorization from the patient’s insurance company. She gets on the phone and waits for ten (unpaid) minutes to get the authorization, but then gets cut off without completing the process.

On a completely separate, but very important, matter, the doctor also happens to note that the patient’s blood pressure is quite high (she assumes hers is too at this point). When she brings this to the patient’s attention, he admits that he stopped his blood pressure pills because the medication was no longer on his formulary.

This is a problem for the patient, obviously, but it’s a problem for the doctor now as well, because the government has started collecting and compiling statistics that rate the quality of a doctor’s care based on such things as the blood pressures of patients treated for high blood pressure. Beginning in 2019, as part of the previously mentioned MACRA program, there will be financial penalties for low quality ratings.

So the government assesses penalties if the patient’s blood pressure is not well controlled, even though the patient’s insurance doesn’t cover his blood pressure medication. The doctor and the patient are caught between a rock (the government) and a hard place (the insurance company).

With so many factors working against them, and especially in light of these looming penalties, the doctor begins to think it would just be better if the patient (whom she has been seeing for years) went somewhere else for his medical care. Why should she be penalized when there are so many factors entirely beyond her control that keep her from adequately caring for such patients?

ADVERTISEMENT

Frustrated, distracted, and now running late for her next appointment, the doctor decides to write up her notes later that night, or maybe early the next morning, because the computer system is just too slow to do it while she is seeing the patient. She knows that she will probably forget important points by the time she gets to it, especially considering all of the distractions she has encountered. She and her colleagues now spend hours after they are done seeing patients trying to catch up on the computer, and this is beginning to take a terrible toll. But that’s just how it is these days.

As the scenario plainly demonstrates, medical professionals are increasingly distracted by a combination of overly burdensome and needlessly complicated government regulation and a health insurance industry that systematically denies necessary medical care.

I am not a traditionalist. There was no golden era of medicine to which I think we need to return. Taking care of patients has always been challenging and it always will be, even under the best of circumstances. But years ago the process was a hell of a lot more straightforward than it is today. I am not advocating a return to the past, but what is happening today is unacceptable. We need a better way forward. Our lives may depend on it.

Matthew Hahn is a family physician who blogs at his self-titled site, Matthew Hahn, MD.  He is the author of Distracted: How Regulations Are Destroying the Practice of Medicine and Preventing True Health-Care Reform.

Image credit: Shutterstock.com

Prev

The last patient of the day gets the least care

June 13, 2017 Kevin 1
…
Next

Physicians are not fundamentally different from their patients

June 14, 2017 Kevin 0
…

Tagged as: Primary Care

Post navigation

< Previous Post
The last patient of the day gets the least care
Next Post >
Physicians are not fundamentally different from their patients

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Matthew Hahn, MD

  • This doctor got COVID. Here’s what it taught him.

    Matthew Hahn, MD
  • These leaders will not fix health care

    Matthew Hahn, MD
  • The demonization of socialized medicine

    Matthew Hahn, MD

Related Posts

  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • Take politics out of science and medicine

    Anonymous
  • KevinMD at the Richmond Academy of Medicine

    Kevin Pho, MD
  • 5 reasons to get involved in organized medicine

    Frances Mei Hardin, MD
  • Medicine is failing rural Americans

    Michael McCarthy

More in Policy

  • Why physician voices matter in the fight against anti-LGBTQ+ laws

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

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • Most Popular

  • Past Week

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

      Carlin Lockwood | Policy
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • What one diagnosis can change: the movement to make dining safer

      Lianne Mandelbaum, PT | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • What one diagnosis can change: the movement to make dining safer

      Lianne Mandelbaum, PT | Conditions
    • Why this doctor hid her story for a decade

      Diane W. Shannon, MD, MPH | Physician
    • Reimagining Type 2 diabetes care with nutrition for remission [PODCAST]

      The Podcast by KevinMD | Podcast
    • How AI is revolutionizing health care through real-world data

      Sujay Jadhav, MBA | Tech
    • Ambient AI: When health monitoring leaves the screen behind

      Harvey Castro, MD, MBA | Tech
    • How kindness in disguise is holding women back in academic medicine

      Sylk Sotto, EdD, MPS, MBA | 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 4 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

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

      Carlin Lockwood | Policy
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • What one diagnosis can change: the movement to make dining safer

      Lianne Mandelbaum, PT | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • What one diagnosis can change: the movement to make dining safer

      Lianne Mandelbaum, PT | Conditions
    • Why this doctor hid her story for a decade

      Diane W. Shannon, MD, MPH | Physician
    • Reimagining Type 2 diabetes care with nutrition for remission [PODCAST]

      The Podcast by KevinMD | Podcast
    • How AI is revolutionizing health care through real-world data

      Sujay Jadhav, MBA | Tech
    • Ambient AI: When health monitoring leaves the screen behind

      Harvey Castro, MD, MBA | Tech
    • How kindness in disguise is holding women back in academic medicine

      Sylk Sotto, EdD, MPS, MBA | 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

The golden era of medicine is never coming back
4 comments

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

Loading Comments...