Before I start, let’s do a disclaimer: I, myself, John Mandrola, having practiced for nearly 16 years, and having saved and lived frugally, am going to be okay. In the game of medical practice, I am in the sixth or seventh inning. I’m almost done. I write such healthcare essays then, not so much because I expect or hope for improved working conditions for me, but rather, that the public know what is happening to the players. For without expert players, the game is diminished. It’s enigmatic, but indeed commonplace of the time, that one feels the need to start non-praiseworthy words with such disclaimer. (At work, one often starts by saying…”I’m not angry; you are a good person who does good work–that I value, but….might you consider…”
Enough already. This post comes after the 323rd time I came home and told my wife, “I need a new job.” Usually these proclamations are uttered after Friday office days–almost never after procedure days, and so far, I have always recovered by Monday. Here goes.
Healthcare reform and its implementation remind me of pregnancy and child rearing.
Humor me for a few paragraphs, please.
At the moment a family learns mom is pregnant, itâ€™s hard to imagine the new life. One knows things will be different, but the distance in the future and the unknown-ness donâ€™t change much in the present. Sure, one worries and nominally prepares, but nothing too significant happens until the new child comes. Itâ€™s after the child is born that parents and current family members discover the chaos. There was no pre-ride; it’s just buckle up and go.
Well, the healthcare reform baby is here. And man is he colicky, sickly and disruptive to the family.
Blissful life for real-world doctors is over. The days of running on time in the officeâ€”gone. The days of having enough time to chat and get to know patientsâ€”gone. The days of doing one thing at a timeâ€”gone. This one hits yours truly the hardest: The days of crafting a narrative to a primary care doctor on a patientâ€”gone. Now itâ€™s a sterile environmentally abusive multi-page list of bullet points included as protection against medical fraud. These are just a few of the new rules. The suffering of course is that many doctors were attached to these self-evidents of good doctoring. Attachment always causes suffering.
Life is changed. The new child has rocked a once happy family.
You have heard this from me before:
These are not complaints; these are the facts.
Back to the new child: We are happy for the new life. We welcome the birth. Bringing healthcare to all citizens is a must. So is doing away with pre-existing conditions. These changes, in their infancy now, will surely make us proud in the future. Some day, perhaps many years forward, there will also be a system that emphasizes healthcare, not sick care. (All parents dream big.)
The problem now is that this baby is unmanageable. The parents and child arenâ€™t getting along well. They are both suffering. The neighbors don’t seem to notice the turmoil.
Take this past Friday: Over-scheduled in the office, patients were frazzled by long wait times and the sight of a rushed doctorâ€”an especially bad thing for arrhythmia patients who do best to avoid anything frazzled.
Why is this? Perhaps itâ€™s the untested unproven EMR system. The time spent in front of that white screen eliminates face time with the patient. But you remember our presidentâ€™s promise: something along the lines that the efficiency of digitizing records will make all this possible. (Grin.)
Perhaps itâ€™s because no employer of ‘providers’ can afford to hire help. Just like an understaffed restaurant, the healthcare delivery system is trying to get by with fewer helpers. (You have seen how well that works.) The doctor used to be just the doctor. Now, along with duties as educator, practitioner and healer, she must also be a data-entry clerk and life coach and protector of health.
More truth: I donâ€™t know a doctor that has increased the number of patients they see. All docs that I know say they are seeing fewer patients.
You know why that is? Itâ€™s because many good doctors, like good parents, fight to do the basics well. We simply canâ€™t abandon our current patients. We try to spend time with them; we try to do the right thing; we shun paternalistic decrees. We must share medical decisions. No one needs a risky procedure or pill. There are options to talk about and then click about. Therefore the suffering continues. Damn attachments.
And then there are these telling iMessages: (Factually received by the author–except with name changes.)
- From the EP lab: With two patients yet to see in the office, one with newly diagnosed severe disease: â€œYour patient is prepped and draped, where are you?â€
- From a medical assistant: â€œMr. Jonesâ€”my next patient–has another appointment, when will you be seeing him? Heâ€™s mad.â€
- From the practice manager: â€œDr. NewGuy decided he wasnâ€™t coming for a second interview. Too much night call, not enough procedures and the salary was too low. Also, he said family was a priority.â€
- From the front office: â€œIâ€™m working on your schedule: Did you know you were booked solid for months?â€
A new child is born. For those already in the family, itâ€™s tough times. There will be adjustments. I can offer this nugget of advice to current family members: learn to be more independent. Learn to demand less of your parents.
In other words, try not to get sick.
Thereâ€™s a plan for that. I think I have mentioned heart disease prevention strategies once or twice.
Seriously, I am not mad.