This health policy consultant may have never cried in a doctor’s office before (“My doctor made me cry. It summed up everything that’s wrong with health care“), but I can practically guarantee that her doctor has. I know this because throughout my 20 years as a primary care physician, I have cried many times in my office, and so have most of my colleagues. I’m not talking about tears for our patients, although we do that, too. I’m referring to tears of angst, anxiety, and frustration over a broken health care system that has forced physicians to become assembly-line “providers” and data-entry clerks rather than allowing us to truly focus on patients.
In her nationally published commentary, the author writes about a negative health care experience with her new primary care physician, caused in part by the intrusion of the electronic medical record. The author describes the doctor as cold and impersonal, clicking away on a keyboard rather than showing her the empathy she so desperately needs.
While the article is poignant, it is also incredibly ironic because, as a Health IT Policy Committee member, the author contributed to the very situation she now bemoans.
In 2011, Medicare enacted recommendations from the committee to overhaul physician documentation, mandating the use of electronic health records meeting specific “meaningful use” criteria. Per the committee’s advice, doctors were now required to manually enter and report certain data points at every office visit regardless of whether those variables had any relevance to the situation at hand. Rather than allowing staff members to enter medical orders given verbally, the committee insisted that doctors enter them personally, including linking multi-digit diagnostic codes, a process that adds time and multiple “clicks” to the physician’s workload. (In 2016, this requirement, called CPOE —computerized physician order entry — was identified as an independent risk factor for physician burnout, yet in 2022, the requirements remain unchanged.)
The Health IT Policy Committee’s recommendations also implemented a physician “report card.” Doctors would now be graded and paid (or not) based on our compliance with government-created “quality measures.” While this policy may have sounded good in the boardroom, it caused the author significant distress in the exam room. She shares her discontent about being “challenged” by the doctor when she requested a particular medication (she didn’t have a corresponding diagnosis in the electronic record) and hurt when the doctor mentioned her elevated blood pressure (a quality measure on the doctor’s scorecard). Ironically, the author fails to identify that her doctor was forced to take these very actions to comply with the requirements that her committee proposed.
I promise you that no physician enters medicine—and certainly not primary care — with the intention of spending 7 to 10 minutes per patient and then hours clicking boxes on a computer. In fact, when you ask physicians what they like the most about medicine, the top answer is “relationships with patients.” But stagnant reimbursement, rising costs and unfunded mandates like those created by the committee have forced physicians to see more patients just to meet their overhead expenses.
Many physicians have reached a breaking point. Being forced to choose between providing compassionate care for patients and serving a broken health care system creates “moral injury,” leading to clinical depression in 20 percent of physicians, with 11 percent reporting thoughts of suicide. If the author cried at her doctor’s appointment, one could imagine that her physician shed a few tears when she read the analysis of her care.
Established doctors are seeking ways to leave the clinical practice of medicine, and medical students are increasingly choosing not to primary care in favor of less burdensome specialty fields. Coincidentally, the author’s experience occurred in my hometown of Fort Myers, FL, an area that has faced a population explosion since the pandemic. My office phone rings off the hook every day with patients seeking a primary care physician, and area practices are so full that few are accepting new patients. The fact that the author even found a primary care physician is itself somewhat miraculous.
The article concludes by urging physicians to solve the broken physician-patient relationship by “rethinking” workflows and “leveraging team members.” Not only will this not work, but it’s a form of victim-blaming. She also advises that doctors “ask hospital or … office administrators to ease off the relentless push for efficiency.” This suggestion betrays a startling lack of awareness of the power dynamic in most health care practices; such a request is more likely to result in the termination of the physician than administrators granting more time with patients. A better solution is for policy experts to use their political influence and personal experiences to advocate for systemic changes that decrease physician burden and incentivize a return to true physician-patient relationships.
Rebekah Bernard is a family physician and the author of How to Be a Rock Star Doctor: The Complete Guide to Taking Back Control of Your Life and Your Profession. She can be reached at her self-titled site, Rebekah Bernard, MD.
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