Friday, July 27, 2012

1:24 am

     Why do doctors work so much?  Or do they?  I can only speak about my own doctor-life.
     It's 1:24 am.  I just returned home from work.  If I hadn't had to make sure all the documentation in the charts was satisfactory, representing everything my staff and I said and did for the many patients we treated today, I would have been home at a reasonable hour, maybe 7 or 8 pm.
     Those of us at the clinic don't need ninety percent of the documentation we stuff into the charts.  My staff and I know our patients well and remember most of what we do--the rest could be notated in a few lines.  We write reams of explanations for people who don't care one bit about our patients:  why we did this, why we recommended that, what advice we gave, what exactly we told patients about how to lose weight or quit smoking...and how many minutes we spent counseling them about their health as a percentage of the total time spent in the exam room with them.
     It's a long day, taking care of patients.  When the last one checks out it's another full day, writing copious, elementary notes in a format legible and comprehensible to billing clerks who live at insurance companies, who might read them, and who are assigned the job of determining whether we deserve to be paid or not.  If the clerks can't read my handwriting, they don't have to pay.  If my signature isn't legible, they don't have to pay.  If they can't understand why I performed an echocardiogram on a patient, they don't pay. We don't get a second chance.
     Who are these people for whom I write so much data?  They are clerks hired to "save" insurance companies money.  I doubt if they have more than tenuous connections to the medical profession.
     Two months ago I gave myself a cortisone shot over the right third metacarpal joint:  I had a trigger finger from writing so much.  My nurse-practitioner needed treatment for carpal tunnel syndrome.  Computer software programs will not make this job easier.  We keep saying we have to stop this job.  The oppression from outside the medical field is too great.  Our bodies and souls are tired of fighting to justify our work.  We want our lives back.  If we're going to be at the office until midnight, it should be to take care of patients, not plead with insurance companies to recognize our work.
     Let's get rid of all insurance companies.  Let patients decide whether and whom to pay for medical care.  Give them a budget, and let them spend it how they choose.  This would restore the free market to medicine.  It would save a lot of money.  And it would restore doctors to the art of doctoring.  

3 comments:

  1. Celeste Segrest ARNPJuly 27, 2012 at 8:41 AM

    Yesterday, while seeing 2 different patients, writting feverisly on their office note, they both asked, " am I really that sick?" My response, " no, our insurance system is." Both patients were very ill, but very grateful they were not inpatient in a hospital, as they were both receiving IV antibiotics. One patient with a history of a recent stroke, which left her one side weakened, and then most recently having to have more cardiac surgery...now with pneumonia, was so relieved she did not have to go back to the hospital for another, "horrible" experience. The other, after one day of IV antibiotics, was able to go to her job that morning, the job that pays her health insurance. Because of these patients, I will stay 4 hours after the office closes in order for them to be happy and healthy. I am fighting to keep the insurance companies from always winning, and profiting.

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