It is no secret that the health care field is changing rapidly. It is also no secret that a lot of physicians are not very happy in their chosen profession. Though I am not one of them, I strongly believe that not all of the changes are good. I have been a Family physician for almost 30 years and some of the changes are downright scary. Most days I feel very sorry for patients caught up in an unruly, extremely expensive, seemingly cold and uncaring, often illogical system. They do not feel good to begin with and the human touch they need and should easily find is being systematically removed. Data entry and endless computer screens and seemingly arbitrary obstacles to helping patients leads to a lot of physician frustration. Inspite of that…or maybe because of it…it is more and more important for all physicians to stand up and fight for what is best for their patients.
So what is best for patients? My belief is that we need more primary care physicians. Electronic data systems have changed everything. I know that I am working longer hours, no longer take a lunch break, and am still seeing fewer patients than I used to see. Along with electronic data systems come all sorts of rules and obstacles that do not help patient care. They are designed to help organize, store, itemize, and categorize information that is not helpful to the physician or patient, but must be desired for some reason by someone somewhere…….researchers? government? computer software engineers? I wish I knew!
When someone is ill, in the ideal circumstance, they are seen by a physician who is capable of diagnosing and competently treating 80 percent of their illnesses, whatever they may be. It is important that the initial physician be able also to recognize the warning signals of a more serious disorder and know where to direct the patient for further treatment. This describes a primary care physician. it does not describe a nurse practitioner or physician assistant. They do not have the same length or depth of training and experience and often don’t know what they don’t know. Currently mid-level physician extenders are to operate under a physician’s supervision, but that is not what is occurring in real time. Often, even in the emergency rooms of America, where the sickest patients theoretically go, a physician is only peripherally involved in the patient’s care. Signing off on a chart without examining a patient yourself is not adequate supervision.
So my wish is that there would be a public outcry for better primary care. Perhaps if the public demanded better primary care, medical schools would respond by helping to direct students to take the path. In the past it has been discouraged and frowned upon. Recently a medical student told me she was advised by the school sponsored financial adviser not to go into primary care because she would have a hard time paying off her student loans. It is true that is is less lucrative than pursuing a career as a specialist. Primary care is still, however, as a career, one of the most rewarding!
As a primary care physician myself, I agree with everything that you’ve said. Intervention/interference in medicine has compromised medical care — especially with what I call “face time” with the patient. Of necessity, you have to have your nose buried in the computer as you continuously plug in data.
All of us seem to long for “the good old day” but in this case our longings are justified.