Doctoring ICD/Pacemaker

Friday Reflection: The cost of joyless caregivers?

Tough week.

Sometimes the catheter falls into place easily, and sometimes it does not. This week, ‘not’ dominated.

I wish it was just the procedures. Difficult cases that string together–and for some reason they tend to come in clumps–was not the hardest part of the week. Hardly. The real tension-inducer was fending off, dealing with, and making peace with the intruders in the doctor-patient relationship.

I didn’t write last night because I was angry and emotional. Smart people have advised against using social media when upset. That’s good advice.

So after a good night of sleep, I’ve come up with a more positive outlook. One that considers the view of the intruders. Most of these folks, like us doctors, are good people trying to do the right thing.

The optimist in me believes there are good people at the DOJ. They believe in their mission to root out the small numbers of predatory heart doctors implanting far too many ICDs and stents. They seek justice. Good on them.

No doubt there also good folks at CMS writing the best ICD coverage decisions they can muster. The problem of course is that ICDs can and do save human life, and therefore decade-old ‘coverage decisions,’ not doctors, determine which Americans might be saved. ICDs cost a lot, and money is tight. CMS has other masters; understood.

Likewise, the good folks at the Duke Clinical research center who write about the large number of non-evidence based ICDs being implanted mean well. By publishing studies that make hard decisions seem easy, they aim to improve the care of patients. Trouble is: in a cubicle with a MacBook, all medical decisions look a lot easier. We regular doctors can do better.

All these folks, including the good people at my hospital who desperately want to stay within the mandates, strive to do what is right.

But…Medical decision-making in this era where very expensive tools are readily available ain’t easy. Neither is advocacy for the patient who falls in the large swath of gray area ignored by the black and white guidelines.

It matters; we care; and thus it’s hard.

I’ll leave you with a final thought. As we reform towards delivering better quality (mistake-free even) healthcare that is available to all and perfectly cost-efficient, has anyone considered the cost or quality ramifications of creating joyless and inflamed caregivers?

What’s your pre-study predictions of this study: Joyless versus joyful caregivers: A randomized controlled trial of Quality and Cost measures.

My take is that taking the fun out of Medicine isn’t neutral.


3 replies on “Friday Reflection: The cost of joyless caregivers?”

Taking the fun out of Medicine is decidedly not neutral. Who, in their right mind, would go to school that long, do residency and internships, incur enormous amounts of debt, risk malpractice suits and tolerate the insurance companies for a career they can’t love? I look at the hours my PCP works and selfishly hope he doesn’t retire before I die, because he’ll be an impossible act to follow. Medical care delivery in this country has become a long, strange trip.

The whole medical profession seems like a very slippery slope. I dropped my first EP and his partners because I felt like a number $$$ rather than a living person. Waiting hours at appointment time. Docs not really up to speed on the case. Piles of records on the floor and on cabinet tops in the office, not to mention the full cabinets. Getting forgot in the hospital for four days when starting a new drug… It was time to find a younger less stressed practitioner and I did. Now two years later getting to see him is like requesting an audience with the pope and he is no doubt getting stressed out with the overload of work. He needs a partner… Seems like I have been here before.

Thank goodness for you and those who still do practice the art medicine. I “failed” all the tests that pointed towards needing a pacer for my SND, yet my EP went ahead and implanted one a years and a half ago. Its only set up to catch me when my HR falls too far south too quickly. At last check I was using the pacer 30% of the time and the rate drop response kicked in nearly 400 times in the last year. As long as I can keep cycling, it’s all good tho.

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