Good Perspective

The following is from A Dr. Sidney  Goldstein. It was in the  Family Practice News though it is syndicated in other pieces.  It is a worth a read:

The New Doctor’s Office

The doctor’s office, at least my office, has changed over the last few decades with an increase in personnel added to make my life easier. Much of it has occurred as a response to the increased billing and authentication process that is required for reimbursement.

After all, when doctors were paid in cash or with a dozen eggs, there was little need for all the paperwork. Health insurance, both private and federal, has been the cause of much of this. At the same time, medical assistants, registered nurses, and a variety of ancillary staff have been added to make the patient’s visit smoother and to acquire the requisite information to satiate the vast network of communications that are generated with each office visit. All of these personnel are now an undisputable requirement for the function of today’s medical office.

In the process, the distance between the physician and the patient has increased. In many offices today, the patient may never see the doctor during the visit. To an increasing extent, the office contact with the patient is solely by an RN or physician assistant. In most cases, patients are satisfied with the service and are delighted not to spend a long time waiting to see the “doctor.” Many of the visits are check-ups or annual or semiannual visits without any associated symptoms that can often be dealt with by a sympathetic and knowledgeable nurse. The patient is the winner to a great extent in this process by acquiring a sensitive ear and an expeditious visit. What is lost is the continued relationship of the patients and their physician. The biggest loss, I would suggest, is the doctor’s satisfaction of providing medical care that comes with every patient encounter, which keeps many of us energized to keep practicing medicine.

Now we have a new vision of how the primary care office of the future will function as a medical home (N. Engl. J. Med. 2012;367:891-3). In this vision, the physicians will be energized by a global payment system that will create an environment in which the doctor’s role is to pass real responsibility to their ancillary staff for which they would be held accountable. According to the authors, the physician’s office will be committed to promoting a healthy environment rather than merely treating disease. Why bother with the simple issue of treating sick patients when you can take on the entire environment of your community to prevent disease?

The authors go on to state that the physician would not waste time focusing on the “10% premature mortality that is influenced by medical treatment.” In this work environment, the physician would be the team manager of a host of ancillary personnel, including medical assistants, RNs, social workers, nutritionists, and pharmacists, to name but a few. The physician would be energized by his or her role as a team leader. The physician, the authors explain, would see fewer patients and would not be caught running from room to room to see patients. Instead, he or she will become involved with care of the “community and understanding the upstream determinants of downstream sickness” and would spend there time in the community “advocating for the local farmer’s market to accept food stamps, organizing walking clubs for physical exercise, and lobbying … to reduce emissions to improve air quality.”

This, of course, is a far cry from the doctors who negotiated the care for their patient for a dozen eggs. It is clearly a role that is foreign to my generation. To some extent, though, patients may well gain in this futuristic environment. They will acquire an empathetic nurse who will be sensitive to their needs and who may be as good as a crotchety overworked doctor. All of the ancillary medical staff will gain a larger and more responsible role in the medical home. The physicians will morph into a new role that is more characteristic of an administrator and less as a practitioner. The doctors, however, will be the biggest losers as they disengage from the patient contact and care that is so crucial to the satisfaction of being a doctor.

Dr. Goldstein, medical editor of Cardiology News, is a professor of medicine at Wayne State University and division head emeritus of cardiovascular medicine at Henry Ford Hospital, both in Detroit. He is on data safety monitoring committees for the National Institutes of Health and several pharmaceutical companies.

It should amaze you that we do so much in medicine to please parties OTHER than the patient.  He really writes this article with a sarcastic tone and with good reason.  Where we are going in medicine is off a cliff.   A Medical Cliff.   It doesn’t have to be that way.  We can do a better job by not billing anyone but the patient and removing the third parties.   It is time to go back to AUTHENTIC MEDICINE!


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Good Perspective

  1. mamadoc
    December 5, 2012 at 9:08 pm

    Team manager of a host of ancillary personnel” and “advocating with the local farmers market”…..shoot me now please

  2. Sir Lance-a-lot
    December 5, 2012 at 11:55 am

    Yeah, this wasn’t what I signed on for, either.

  3. Pat
    December 2, 2012 at 9:40 am

    Oh yes, when contemplating med school, my hope was for exciting roles like “advocating for the local farmer’s market to accept food stamps.”

    That is so sad it’s funny.

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