I have a “Cash-Practice”…the original DPC. I charge fair prices for excellent care. Seven years ago I decided I could no longer be hostage to insurance companies telling me what my care was worth. I have one staff-person besides myself. We love our patients, our practice and our small rural community.
I have watched the state of medical care deteriorate around me especially over the last 5 years. It used to be that “horror” stories of bad care were spoken of in hushed tones once a quarter or every six months. Now, I can honestly say that I hear such stories at least monthly (and sometimes more). I strongly advise anyone who needs to be hospitalized to have someone stay with them (for safety).
We have been lied to. Electronic records and checklist/protocol medicine are not the panacea to better patient care. They are not about the patient. Those are about the payer…better outcomes, less cost, and ability to mine data later on. In the rush to be liked and prove that we are not the horrible murderers that the media and medical boards would have us believe, we have pointed and clicked our way to horrible care and allegiance to the protocols first and foremost.
This path caused the following appalling results:
- An elderly patient with multiple medical problems who had a high fever sat in an ER with no fluids of any kind for 12 hours.
- The ordering physician was not called for 22 hours about an alarming foreign body in a patient’s lung. The excuse was that the hospital no longer supplied support staff to help make the calls.
- Hospitalized patients regularly do not get requested medication because it has not been ordered, and then the doctor orders it, the order still has to go to to the pharmacy. Then the pharmacy has to load the medicine into the “diebold”. Then the nurse has to have time to give the medicine.
Sound awful? It is!!
If it is a simple issue like a mild headache then waiting 2 or 3 hours maybe annoying but tolerable. What if your child has a high fever that has not broken with Tylenol and she needs some Motrin? And you have to sit and watch your child suffer. And you cannot do for her what you would do at home! Been there. Done that. I finally got my thermometer, pulse oximeter, Tylenol and Motrin from home. And I wondered why I was paying through the nose for horrible care.
Being a doctor is a sacred trust. I promise to help keep my patients healthy. I took the Hippocratic Oath. I promised first to do no harm. I can’t just say, “not my problem, it’s 5 o’clock and I don’t have staff to help me make those calls.”
What we are losing with the “Taylor Approach” and EMR’s and protocol driven medicine is the reason we got into medicine in the first place…taking care of patients… who are our friends and neighbors even if it is on a macro or global sense. We owe each one of them our best, every day. When we find we can no longer do that, we either need to fix the system so we can do it again, or get out of medicine.