Saturday, October 20, 2012

My Clinic is in Line with Affordable Care

     The Affordable Care Act spotlights primary care as the answer to many of the nation's healthcare problems.  Money for healthcare, it says, should be spent on physicians who meet quality standards, prevent bad outcomes, and keep overall costs down.  These have been precisely my objectives with all the patients I've seen in the last twenty years.  Even those who came to see me because of a cold, or an ingrown toenail, were subjected to questions about their overall health--usually questions unrelated to their presenting complaint.
     I didn't know this was wrong.  It didn't occur to me that someone in the government might think I was just trying to make a few extra bucks on the patients who had chosen me to look after them.  Sure, they came in with runny noses and sore toes, but if I could get them to think about quitting smoking, or wear their seat belts or let me check out the nagging GI or neurologic symptoms they listed on their intake questionnaires, I felt I was doing everyone a favor.
     Family practice training focuses on prevention.  Prevention requires physicians to ask about subjects patients are reluctant to bring up--but won't forgive, either, if a doctor rushes in and out without addressing anything but the chief complaint.  These include questions about incontinence, drinking, sexual functioning, drug use, bad eating habits, depression, insomnia, early warning signs of heart disease, memory loss, and cancer risks.
     Patients especially won't forgive--nor should they--a doctor who doesn't ask age-appropriate questions and find underlying problems, especially if they develop a serious health problem later.  Most problems can be prevented, or caught early, by a circumspect physician.
     The statistics on malpractice lawsuits are proof that patients want more than acute care:  failure to make an important diagnosis in a timely way is the leading cause of medical malpractice cases.  Failure to diagnose cancer is at the top of the list.
     But patients never walk in and say, "Doc, I think I might have cancer."  It takes a discerning diagnostician to ask the right questions, and to feel around in the darkness for information.  Feeling around in the darkness often means asking more questions, doing a careful physical exam, and running a few tests.  Better to pay for information early, than to shell out for end-stage disease later--not to mention the pain and suffering that goes along with delayed diagnoses.   At least, that's been my philosophy.  I have been an aggressive physician, with the attitude that if you don't ask, you won't get clues, and if you don't look, you won't find anything.
     In a turnaround typical of government, the very methodology I have been using is likely to be the subject of the government's investigation of my clinic, as well as an example of the new solution to our healthcare woes in America.
     How, I ask, can I be indicted for practicing medicine in a way that is now being touted as the standard of care, and the basis for the Affordable Care Act?
     The new instructive is to allow primary care doctors to be at the helm of the medical system, and to spend time and money early as a way of preventing costly extravaganzas in the ICU's of our hospitals later.  Well, government folks, that's been my modus operandi all along.  If you're going to label it fraud, I'd like to know how my style of medical practice differs from what the Affordable Care Act is now going to mandate.    

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