Last week, I presented some of the top frustrations that patients have with the medical profession. As promised, here is a sampling of physician frustrations. This is hardly a scientific survey but is taken from my own experience and conversations with colleagues over the years.
The Electronic Medical Record (EMR) Industrial Complex. Odds are very high that if you query your physician about the most frustrating aspect of their professional, that EMR will be in the top 3. It continues to sap hours away from face-to-face time with patients. A glitch in the computer system can paralyze the office. And nothing strikes fear in medical providers more than a looming EMR upgrade. An upgrade means that whatever processes I have barely memorized will become null and void.
The Electronic Portal. This is
the computer’s ‘in basket’ into which all communications, test results, patient
inquiries, pharmacy issues, medication refill denials, notes from billing coders,
messages from colleagues and orders to sign are dumped. It’s nearly impossible to scrape this basket clean. I liken it to shoveling your driveway while
it is still snowing – a downright Sisyphean task! It’s not a fair fight. If I didn’t have patients to see, then I
might have a chance to prevail in this duel.
Doctor-patient relationships under stress. The DP relationship is a different entity
today. Patients watch their doctors
pecking away on a keyboard. Eye contact? What’s that?
Moreover, patients often can’t see their own physician who’s booked out
for months so they are shunted to a nurse practitioner or to an Urgent
Care. Obviously, such a reality dilutes
the bond that should exist between a patient and their primary doctor.
Patients who are late for their appointments. Yes, stuff happens and all of us can be late. But if I arrive late to see a movie, the only person being punished is me. If you are late for a medical appointment, and the doctor agrees to see you, then you are punishing every patient scheduled after you. It would seem to be common courtesy to plan to arrive early just in case there might be an unforeseen delay. Late arrivals would nearly cease if any late patient were automatically cancelled, but most of us doctors are employers are not willing to adopt such a draconian response. But when we extend some grace to you, it will be at the expense of other on-time patients.
Drug denials. The
never-ending denials of physicians’ prescriptions over time can transport a
docile doctor into a cauldron of frustration.
And don’t even mention the phrase prior auth within earshot of
your doctor without first issuing a trigger warning.
Perform! The
inexorable pressure for doctors to increase their productivity without
sacrificing patient satisfaction or quality metrics is all fuel for burnout.
Lack of Appreciation
It’s shocking how many physicians and medical personnel at large, do
not feel valued by their organizations. Platitudinous
and depersonalized e-mails expressing appreciation are not sufficient Making valuable personnel feel valued shouldn’t
be hard or rare.
Loss of autonomy. Most
physicians today are employed. This
transition can be more challenging for those who once were private practitioners. Imagine being the boss of your own business
and now being the boss of nothing having to make routine requests of
administrators which can be summarily denied.
Those of us who are lucky have managed to compartmentalize the above so we can focus on why we became doctors in the first place. Fortunately for me, the profession continues to bring me joy and satisfaction.
No, the thing that gets me the most is the absurd creeping bureaucracy, the oversight, the paternalism of the insurance companies, licensing boards, medical boards, and hospital administrations. After 40 years of practice, last week I was informed that I had to complete this battery of absolutely juvenile online courses on all sorts of irrelevant politically correct nonsense, cultural competence, fall risk, dementia, HIPAA, physician conduct, etc. etc. These were PowerPoint presentations that were easily geared for 10th graders. Why, after 40 years of practice, my continued viability as a medical staff member depended on completing an infectious disease module including HOW TO WASH MY HANDS is absolutely beyond me. But the cultural competence really gets me, and it’s ironic that just tonight I got a laudatory note from an old colleague talking about how instrumental I was in his own personal development because he had consulted me once to remove a foreign body from the back of a guy that had all sorts of hideous tattoos, including a swastika on his forehead (I’m Jewish).
ReplyDeleteAfter spending much of my career treating non-English-speaking Russian and Somali immigrants, obnoxious heroin addicts, Nazis, incarcerated felons, murderers, alcoholics, patients bombastically sharing their repugnant politics with me - I don’t really think I need some compliance or diversity officer lecturing me about cultural competence. Have a good night.
Joe, I thank you for your thoughtful comments. Your frustration is clearly evident. Those looking in at our profession may not be able to grasp the obstacles, compliance mandates, EMR, billing & coding, insurance denials, etc. I have done my best to compartmentalize this which allows me a joyful practice currently. For me, this has been facilitated by my leaving hospital and weekend and on-call medicine far behind me. I wish you well. MK
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