Physicians

Let Doctors Be Doctors

flying cadeuciiIt’s a strange business we are in.

Doctors are spending less time seeing patients, and the nation declares a doctor shortage, best remedied by having more non-physicians delivering patient care while doctors do more and more non-doctor work.

Usually, in cases of limited resources, we start talking about conservation: Make cars more fuel efficient, reduce waste in manufacturing, etc.

Funny, then, that in health care there seems to be so little discussion about how a limited supply of doctors can best serve the needs of their patients.

One hair-brained novel idea making its way through the blogs and journals right now is to have pharmacists treat high blood pressure. That would have to mean sending them back to school to learn physical exam skills and enough physiology and pathology about heart disease and kidney disease, which are often interrelated with hypertension.

Not only would this cause fragmentation of care, but it would probably soon take up enough of our pharmacists’ time that we would end up with a serious shortage of pharmacists.

Within medical offices there are many more staff members who interact with patients about their health issues: case managers, health coaches, accountable care organization nurses, medical assistants and many others are assuming more responsibilities.

We call this “working to the top of their license.”

Doctors, on the other hand, are spending more time on data entry than thirty years ago, as servants of the Big Data funnels that the Government and insurance companies put in our offices to better control where “their” money (which we all paid them) ultimately goes.

In primary care we are also spending more time on public health issues, even though this has shown little success and is quite costly. We are treating patients one at a time for lifestyle-related conditions affecting large subgroups of the population: obesity, prediabetes, prehypertension and smoking, to name a few that would be more suitable for non-physician management than hard-core hypertension.

It is high time we have a serious national debate, not yet about how many doctors we need, but what we need our doctors to do. Only then can we talk numbers.

Hans Duvefelt, MD is a Swedish-born family physician in a small town in rural Maine. He blogs regularly at A Country Doctor Writes where this piece originally appeared.

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Charles KenneyPerryallanbirdPeter1 Recent comment authors
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Charles Kenney
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Charles Kenney

Excellent post. “It is high time we have a serious national debate, not yet about how many doctors we need, but what we need our doctors to do…” Really well said. Dr. Jack Cochran and I have tried to contribute to this debate with our new book, THE DOCTOR CRISIS.

http://www.bostonglobe.com/arts/2014/05/04/book-review-the-doctor-crisis-how-physicians-can-and-must-lead-way-better-health-care-jack-cochran-and-charles-kenney/JG2YPCAexXSpEqRcCi4FbI/story.html

allan
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allan

“One hair-brained novel idea … have pharmacists treat high blood pressure.”

That idea is an insult to any respectable hare.

Perry
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Perry

Heck, why not just teach chimpanzees to do it, then we could pay them peanuts and they’ll be happy.

bird
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bird

love the title “let doctors be doctors” that is so true. While we are making a push to have ancillary staff work to the full extent of their license, we have done the complete opposite for the doctor. We have been told to work well below our license, we are data clerks and transcriptionist that take up half of the time we have with patients.

Peter1
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Peter1

bird, if you want to “rid” yourself of paperwork go cash only, no insurance, gov’t or private. No one to account to except yourself.

bird
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bird

Your are correct, i should, but dont have the nerve to do it yet, direct care medicine has been about the only form of medicine to actually bend the cost curve and improve quality, examples are turntable medicine in vegas, qliance in northwest etc. I applaud those guys and envy what they are doing. But i am hospital owned with a very strict no compete clause.

Peter1
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Peter1

Doc Hans, without the data how do we analyze, investigate and justify anything – on a national scale?

BCBS ads say we spend 50% more on administrative tasks than other countries – those would be largely single-pay countries. That’s your answer.

“In primary care we are also spending more time on public health issues, even though this has shown little success and is quite costly.”

Public health should be handled by public health nurses in the community. Spend the money there.