Stanley Feld M.D.,FACP,MACE
The healthcare system is dysfunctional. All the stakeholders are to blame. President Obama’s healthcare reform act is going increase this dysfunction because the healthcare reform act does not solve the basic problems in the healthcare system.
For many physicians, the realities of our health care system have led to an inevitable conclusion. In order to survive, physicians must abandon the very ideals that drove them to become physicians.
The problems that will not be solved but will be intensified under Obamacare are the complexity of billing codes, the threat of malpractice, the frustration of not having the time to relate to patients effectively and the burden of the administrative bureaucracy (paper work). Patients have been conditioned to be suspicious of physicians’ skills and motives. Physicians have become suspicious of their patients.
Ryan Flesher, MD an emergency room physician directed and produced a documentary, “The Vanishing Oath” with Nancy Pand. The dysfunction of the healthcare system is described from an emergency physician’s perspective.
It is the story of a physician’s disillusionment with his life’s dream and profession. It is the story of his discovery that many physicians feel the same way. It is a story of emotional exhaustion.
“Dr. Flesher’s story is about himself, and also other physicians caught in the whirlwind of the healthcare system, their day-to-day exhaustion, and unhappiness woven in a tightening bureaucratic vice.”
He describes becoming increasingly unhappy in a system that seemed to unravel and become "critically wounded.” Doctors are bailing out of their chosen profession because they are not able to have enough time for their patients or themselves.
“Flesher hated being a physician in a manner that he says the system demands. “It was just pretty frustrating," he says. "Since I was young, I focused on becoming a doctor." Over time, as he grew more unhappy, " I began asking myself, ‘what’s wrong with me, why am I so unhappy?”
It was therapeutic for him to make this film. It was sad for him to see physicians weep with despair over their profession. Physicians were frustrated that they could not understand their patients’ illness beyond what their charts tell them. The time allotted to each patient has been truncated.
Medical care is an art as well as a science. Most physicians believe in order to be therapeutically effective there is more art than science in the patient physician relationship.
President Obama’s healthcare bill and Dr. Berwick’s philosophy assumes that medical care can be commoditized. They are wrong. They are going to destroy the physician workforce. The result will be many unintended consequences with a restriction of access to care and rationing of care.
These unintended consequences are already occurring in the dysfunctional healthcare system. President Obama’s healthcare reform act does nothing to correct the dysfunction which will only intensify.
"We’re just jammed, ambulances everywhere, beds full, I’m carrying 16 or 17 patients of my own, pretty sick," Flesher says in the documentary. "Before I go three steps, I’m confronted with the billing agent for the ER who says we can’t get paid because my charts — eight of nine — required review assistance components. Two, I’m confronted by the service rep for the hospital (who says) my patient satisfactory scores are only 93% – we’ve got to be above 96."
"The CEO says we are getting backed up (in the emergency room), and we need to get patients through the ER quicker," he adds. "The Joint Commission rep says she caught me drinking (soda) three feet too close to the patient care area and she’s going to cite me for—whatever. I didn’t even see a patient yet and my mind is already clouded."
It reminds me of the funny bit done in the 1960s.
“My name is Jose Jiménez. Jose said, “How would you like to be the monkey that presses the button and puts the scientist into space?”
The healthcare system is sick and getting sicker. The losers will be patients, physicians, and taxpayers. The winners will be the government bureaucrats and the healthcare insurance industry.