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The Red-Tape Blues

Three physician bloggers bemoan—and cope with—administrative headaches that impede caregiving.

FALL 2013
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Frustrated with a health care system that impedes practicing medicine, these physician-bloggers search for ways to dig out from under piles of paperwork and reconnect with patients.

Your Cheatin’ Heart
Adapted from a June 23, 2013, post on Musings of a Distractible Mind, a blog by primary care physician Rob Lamberts.

Hi.

I’m Rob, and I am a recovering doctor. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid and insurance companies. I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out), but things are looking a lot better.

The key was when I realized that the system wasn’t going to change no matter how much I accommodated its unreasonable requests. I felt that if I only did what it asked of me, however unreasonable, it would stop hurting me and, more important, my patients. But I’ve come to see that all the promises to take care of me and my patients were written in sand, and that it couldn’t resist the temptation to cheat on me. I tried to do what it asked of me, but as time went by I couldn’t take how dirty it made me feel.

I want to believe it was sincere when it told me it wanted to change. I think at its core, it wants to help patients and doesn’t want to go on those spending binges. But no matter how sincere the promises sounded, I was always left alone as it threw its money at every sexy treatment, procedure or drug that walked by. Then it would go off on tirades about how much I spent and that I didn’t do enough to keep to our budget. It was always my fault. I think it’s just easier to pass blame to others than it is to do the hard things necessary to really change. To be honest, I think it was terrified at how much real change would hurt.

Crisis of Conscience
Adapted from a March 26, 2013, post on In My Humble Opinion, a blog by Jordan Grumet, an internist in Highland Park, Ill.

The world is changing for providers. Heavily Medicare-weighted, the past few years have seen a proliferation of administrative paperwork. When not overwhelmed with forms, we are hunched over computers inputting inane information like ethnicity. What we are not doing is taking care of patients. We are not interfacing with those we have sworn to care for. The covenant I have so often written about is being replaced with vague ideas of community health and meaningful use. In no uncertain terms, we are letting you (the patient) down. This makes me ill.

A few months ago, I had a crisis of conscience. I could no longer sign off on this willful subjugation of the doctor/patient relationship. So I crunched the numbers. What I found shocked me. Most of the revenue from my practice comes from nursing home work. In other words, all those hours spent in the office and the hospital did exactly one thing: They paid the bills for that very office and all my employees. It’s a zero-sum game. I would be better off economically if I finished each day at 9 a.m.

How to Cut the B.S.
Adapted from an Aug. 18, 2013, advice post written by electrophysiologist and guest blogger Jay Schloss on the blog of Dr. John M, also an electrophysiologist.

Here are some tips for survival in the new health care environment:

Minimize the B.S. Don’t confuse box-checking with delivery of health care. Sail through the B.S. as quickly as you can. Save your creative juices for the parts of your documentation that people actually read. Just focus on meeting regulatory compliance and not setting yourself up for a lawsuit.

Mobilize support for change. Do your job, but don’t take all this lying down. Doctors got into this mess by not speaking up. If we continue to roll over, it’s only going to get worse. Make yourself a positive agent of change. Speak up in e-mails, meetings and hall conversations with administrators. Get a voice in social media. Because most of your colleagues are as passive as deer in the path of a truck, your voice can be heard.

Hold fast to your values as a doctor. No matter how bad it gets, do not‚ I mean do not, let go of your values as a caregiver. You know that quality metrics do not ensure quality. Keep doing the extra stuff that regulators don’t notice or measure. If that means seeing fewer patients, then so be it. Each patient you treat needs to see you at your best.

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