As I look back over my blog, I realize that my central premise is faulty. The medical complex I grew up in is long gone. New docs are graduating this summer and entering a system so foreign to my background as to be almost unrecognizable.
When I graduated, everybody went into the private sector, either hanging out their own shingle or joining an established practice. Today’s docs will sign employment contracts with large medical conglomerates. They will be given an employee manual outlining their responsibilities to the corporation and the corporation’s patients.
Their marching orders may not tell them how long to spend with a patient or what to prescribe but, instead, will give them parameters that they must follow in order to be financially successful. The electronic medical record (EMR) will grade their care: what percent of their prescriptions are generics, what percent of their specialty referrals were to docs employed by the healthcare conglomerate, how many antibiotics did they write, how many patients did they see per hour, etc.
In the new world, my proposed book is worthless. Yes, a small percentage of the doc’s overall performance rating will be dependent on patient feedback’ and, following the guidelines I’ve laid out, patient satisfaction should be high but it’s going to be almost impossible to be a good listener, a caring and comforting doc and address the demands of an uncaring EMR whose only goal is to collect data. Much of what transpires between the doc and the employer will be invisible to the patient; but enough will be visible that, inevitably, the patient will be unhappy and uncomfortable.
Sounds depressing, doesn’t it! It’s time to put the top down and go for a ride. It’s almost impossible to be depressed while cruising, top down, on a sunny summer day. For those of you who don’t have a convertible, my suggestion is to find an old doc who is still independent, not yet disillusioned and settle in with her/him. If you can’t find an old doc, find one of the few who work for physician owned groups.
Meanwhile, I’m going to take a brief sabbatical from writing while I reassess the premise behind this blog. Feel free to make any suggestions or share any thoughts you have with me.
Here’s your joke of the day:
My grandfather, Randy, was a brick layer.
He said: “I was a brick layer for 10 years, but no one calls me Randy, the brick layer.
I was a farmer for 20 years, but no one called me Randy, the farmer.
But you have sex with just one goat…”