Temples to the Gods
What’s a house call, you ask? For those of us old enough to remember, a cough, a fever, an upset stomach, a runny nose, a child’s pinworms, or any manner of body wake-up call left us concerned, but never troubled, for we knew that we could depend upon our trusted physician in white armor to ride to our doorstep on four-wheeled steed. Something has been lost in translation, however, as that friendly domestic cup of tea shared by doctor and patient has been transformed into a mad dash to the emergency room and a rush to judgment, as we chastise a past hero who now reminds us that time is money. So, are the healers of today, with all their bells and whistles, airs of superiority, and self-built clinical temples, better at their art and science than their good-old, bespectacled ancestors, who bore little black bags instead of handheld computers? Is technology mightier than compassion? Are robot-guided catheters and probes more efficacious in the long term than the touch and comfort of a healing hand? Can some suitable compromise be reached? Those and other questions need to be answered, before we embark on that expensive overhaul of the health care system we call universal health insurance.
Medicine has become a business, like many other noble endeavors, and its proprietors seek growing clienteles through self-promotion, whether that be media advertisement or construction of palatial offices and clinics that provide a semblance of professional success to new generations raised on material excess. After all, a doctor in rags, driving a jalopy, certainly does not project or warrant trust, in much the same way as a down and out real estate agent or practitioner of the bar. Furthermore, a “mine is bigger than yours” attitude drives a competition for numbers, both in terms of patients and consequent hard cash, as physicians vie for their piece of the American dream by drawing patients across their thresholds and then treating them with production-line efficiency. Damn feelings and close interpersonal contact, as terse replies to questions and directives to consult the nurse engender little satisfaction, growing hostility, and a sense of loss and abandonment in those seeking solace and perhaps even a cure from the men and women in white.
Those venerable statistics we like to quote have shown big-clinic medicine is a drain on pocketbooks, resulting in 60 percent of all bankruptcies in the United States in 2007 being owed to runaway health care costs. Seeing a different patient every 15 minutes does little to reel in costs or improve patient satisfaction. It is high time for a new paradigm, called “patient centered” practices, that incorporates both increased time with patients and an emphasis on prevention and education to keep them healthy, so that incessant and expensive referrals to specialists become a thing of the past. Not an easy task, you say. You’re absolutely right. To streamline procedures, processes, and administrative costs, with consequent reduction in the health care deficit, all eyes will once again have to turn to that often-touted cure all for everything costly, namely, technology, in the form of online appointment scheduling, electronic medical records, prescription of medications by computer, and virtual office visits by telephone and e-mail. As impersonal as it may seem, and as uncomfortable as we may feel about it, technology can, indeed, raise the bar of primary health care and even personalize it, when placed in the hands of practitioners in the trenches who are unafraid to try something new to safeguard a nation’s health on the verge of financial chaos.
Technology is not for everyone, however, and it will not solve all of this country’s health care issues. The high priests, keepers, and gods themselves in the temples warn that electronic patient records can be hacked, computer downtime can make patient records inaccessible for hours, small primary care clinics are not the answer for patients with multiple health issues, and small practices do not provide safe haven for practitioners who lack technical or business skills or who fear private fees versus salaries in these times of economic uncertainty. Reducing daily patient loads from 25 to 10-12, with longer patient appointments of 30 to 60 minutes, may not be the answer either, as primary care physicians watch impotently as their salary dollars undergo erosion. That, in part, is the reason why primary care remains the most unattractive field of medicine, with practitioner numbers dwindling due to the lowest compensation of any medical specialty. In 2008, the average annual salary of a primary care physician was $201,555, versus $356,166 for a general surgeon and $614,536 for a neurological surgeon. Poor babies! Lest they recall the hordes of unemployed currently walking the bread lines!
All this discussion points to a need for something to be done, and immediately. When general practitioners are scheduled to see 25 or more patients per day in large clinics or temples, whichever you prefer, sufficient time for thorough examinations, adequate discussions, and proper preventive care goes out the window, and the end result becomes the needless ordering of superfluous tests and unnecessary referrals to specialists, all at the expense of national health care ledgers that are rapidly approaching the bottom line. And heaven forbid that we discuss the unquantifiable toll on patients’ psyches of noisy and crowded waiting rooms, and the status quo, for lack of a better word, of getting in and out without wasting the doctor’s time with questions. Ignorance not being bliss in this case!
Is technology the answer? Perhaps not, in all cases. However, it can streamline processes and make small primary care practices financially viable in the current health care market, reducing their costs to half, from 60 percent of income down to 30 percent. That translates into better patient care, with physicians able to see fewer patients without sacrificing their almighty incomes. Tearing down the temples in favor of small storefront clinics with advanced technology may be a return to the future, and the name of the game. Perhaps little black bags can even be made big enough to hold laptop computers.
© 2009, Albert M. Balesh, M.D. All rights reserved.
Medicine has become a business, like many other noble endeavors, and its proprietors seek growing clienteles through self-promotion, whether that be media advertisement or construction of palatial offices and clinics that provide a semblance of professional success to new generations raised on material excess. After all, a doctor in rags, driving a jalopy, certainly does not project or warrant trust, in much the same way as a down and out real estate agent or practitioner of the bar. Furthermore, a “mine is bigger than yours” attitude drives a competition for numbers, both in terms of patients and consequent hard cash, as physicians vie for their piece of the American dream by drawing patients across their thresholds and then treating them with production-line efficiency. Damn feelings and close interpersonal contact, as terse replies to questions and directives to consult the nurse engender little satisfaction, growing hostility, and a sense of loss and abandonment in those seeking solace and perhaps even a cure from the men and women in white.
Those venerable statistics we like to quote have shown big-clinic medicine is a drain on pocketbooks, resulting in 60 percent of all bankruptcies in the United States in 2007 being owed to runaway health care costs. Seeing a different patient every 15 minutes does little to reel in costs or improve patient satisfaction. It is high time for a new paradigm, called “patient centered” practices, that incorporates both increased time with patients and an emphasis on prevention and education to keep them healthy, so that incessant and expensive referrals to specialists become a thing of the past. Not an easy task, you say. You’re absolutely right. To streamline procedures, processes, and administrative costs, with consequent reduction in the health care deficit, all eyes will once again have to turn to that often-touted cure all for everything costly, namely, technology, in the form of online appointment scheduling, electronic medical records, prescription of medications by computer, and virtual office visits by telephone and e-mail. As impersonal as it may seem, and as uncomfortable as we may feel about it, technology can, indeed, raise the bar of primary health care and even personalize it, when placed in the hands of practitioners in the trenches who are unafraid to try something new to safeguard a nation’s health on the verge of financial chaos.
Technology is not for everyone, however, and it will not solve all of this country’s health care issues. The high priests, keepers, and gods themselves in the temples warn that electronic patient records can be hacked, computer downtime can make patient records inaccessible for hours, small primary care clinics are not the answer for patients with multiple health issues, and small practices do not provide safe haven for practitioners who lack technical or business skills or who fear private fees versus salaries in these times of economic uncertainty. Reducing daily patient loads from 25 to 10-12, with longer patient appointments of 30 to 60 minutes, may not be the answer either, as primary care physicians watch impotently as their salary dollars undergo erosion. That, in part, is the reason why primary care remains the most unattractive field of medicine, with practitioner numbers dwindling due to the lowest compensation of any medical specialty. In 2008, the average annual salary of a primary care physician was $201,555, versus $356,166 for a general surgeon and $614,536 for a neurological surgeon. Poor babies! Lest they recall the hordes of unemployed currently walking the bread lines!
All this discussion points to a need for something to be done, and immediately. When general practitioners are scheduled to see 25 or more patients per day in large clinics or temples, whichever you prefer, sufficient time for thorough examinations, adequate discussions, and proper preventive care goes out the window, and the end result becomes the needless ordering of superfluous tests and unnecessary referrals to specialists, all at the expense of national health care ledgers that are rapidly approaching the bottom line. And heaven forbid that we discuss the unquantifiable toll on patients’ psyches of noisy and crowded waiting rooms, and the status quo, for lack of a better word, of getting in and out without wasting the doctor’s time with questions. Ignorance not being bliss in this case!
Is technology the answer? Perhaps not, in all cases. However, it can streamline processes and make small primary care practices financially viable in the current health care market, reducing their costs to half, from 60 percent of income down to 30 percent. That translates into better patient care, with physicians able to see fewer patients without sacrificing their almighty incomes. Tearing down the temples in favor of small storefront clinics with advanced technology may be a return to the future, and the name of the game. Perhaps little black bags can even be made big enough to hold laptop computers.
© 2009, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/05/2009 02:09:00 PM
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