With new changes, health care industry is focused on the wrong things
It used to be that a physician’s note contained dubious penmanship but concise, insightful information that guided the evaluation and treatment of the patient. Now notes are pages long, often containing verbiage simply cut and pasted from previous notes so as to speed the awful process or maybe to fulfill the requirements for “billing at a higher level.” I may have to dig through scads of detailed “data” that justify payment but don’t necessarily result in better care. This system clearly needs some work. Or a boycott.
When I chose to leave the world of academic medicine for private practice, I went back in time. I joined a small practice that prides itself on service. There is no answering machine. Your call is answered by an honest-to-goodness human being. Because it’s a small group, we’re not yet required to switch to electronic medical records. I write, by hand, notes that contain the information I need to help you feel better. When I finish our visit, I dictate a letter and often call or text your referring physician to let them know what’s going on. I bill based on the notes, but no one’s costing out the “elements of the encounter.”
So old school. So unacceptable. So effective.
I feel as if I’ve stumbled into a medical oasis. My time is spent being a doc rather than a scribe or grocery clerk ringing up a sale. My time is spent interacting with a person who wants my help; it isn’t diluted with a perverse treasure hunt for clinically irrelevant but EMR-encouraged information. I’m happier in my work than I have been in a decade. My patients now are happier than my patients then. Everybody recognizes and responds to good service, whether it’s in a doctor’s office or an auto repair shop.
I have no doubt that my little oasis will come under the thumb of the new era of health care. And when that happens, we’ll do our best to make it work for our patients. But for now, while it lasts, I’m going to enjoy being the kind of doc that I always wanted to be.
Michael P. Jones is a gastroenterologist in Virginia. He wrote this for the Los Angeles Times.
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