General Medicine Health Care Health Care Reform

Let’s be clear on why most doctors are skeptical of the recent healthcare bill…

My infinitely more famous colleague, Dr Wes has a very nice summary piece on how the recent healthcare reform bill will affect doctors. It is very well written, concise and instructive.

I get it. I don’t here Fox news.

There is good in the bill, like the pre-existing condition clause, and prohibiting an insurance company from dropping coverage after an illness.

Many think we doctors are against the bill because it will make us less rich. This is not what I hear from Dr Wes, and not how I, and most doctors feel –at least the ones I roll with.

What hurts doctors most is how the present convoluted delivery system affects our ability to care for people.   The seemingly infinite complexity of the healthcare system plus the monopoly-like costs of healthcare are major problems for the doctor-patient relationship.   Mysteriously, these two elephants in the room are ignored by the bill, despite the 2700 pages.  

As humans, doctors are affected by our milieu. Take as one of many examples: the consequences of cutting compensation. Most doctors will simply see more patients, which means less time per patient.  Simple human nature.

When the office is packed, patients are waiting, and the EP lab is calling asking why you are late (again) to get started, how likely are you to engage in the mentally exhausting, but occasionally effective, battle of convincing the overweight, hypertensive AF patient on the importance of better health choices? And yes, there is a difference between saying, “you need to lose weight,” and really engaging. (Though, the little checkbox in the EMR doesn’t distinguish between these two. My code words in the dictated, non-EMR note reads something like “I beat him up pretty good on lifestyle modifications.” This is code for: I really tried.)

I remember this winter’s major snow storm.  Snow in the south means many no-shows.  What a pleasure it was to doctor at such slower speeds. Every day of doctoring is good, but that snowy day was especially rewarding for patients and doctors alike.

Just slow down Mandrola, one might say. I could tell you why, but in the interest of brevity, trust me, it is not that simple, even for one who prides himself on simple solutions.

Doctoring on snow days must be how it was in the good old days.

One last news flash from the inside:

For the most part, doctors are chronic over-achiever types who are motivated primarily to be really good at their trade. This motivation often makes them good at little else, like advocacy in politics. Really, it is only a scant few who behave in a predatory way motivated only by profit.  These unfortunate transgressions provide much negative publicity, which in this headline intensive society is inappropriately generalized to most of us who toil to do what is right.

Moving on to other topics, soon.