DOCTORS ’ LOUNGE
DOCTORS ’ LOUNGE
MEDICAL TITANIC
Larry Griffin , MD
The Titanic was sunk by a massive iceberg unseen until too late to avoid . Thousands of lives were lost and the world mourned the event as a massive disaster . We are now facing the equivalent of tens of thousands of Titanic-sized disasters on a daily basis as a result of the rapid deterioration of the practice of medicine in this country . The difference is that the Titanic disaster was in every newspaper and on the tip of everyone ’ s tongue . With the issue in medical practice , however , such disasters individually are rarely even recognized , and if so , only by those most closely aligned to them , assuming they are singular events , not the tip of a medical iceberg .
I don ’ t believe anyone goes to medical school to be a mediocre physician . We are , by our very nature competitive , ambitious , energetic , enthusiastic , inquisitive men and women who thrive on being the best at what we do . Without that competitive streak within us , none of us would have gotten into medical school in the first place , much less successfully completed it and the requisite training which follows .
Our schedules have always been demanding , because we made them so . After all , professions are what we live , not what we do . Our profession , more than most , defines us , not solely , but certainly in large part . We willingly make the sacrifices we do in order to best serve our patients and our profession - to make our community a better place one patient at a time .
I have witnessed , however , as have many of you , the massive changes in the practice of medicine over the past 10 -20 years . Corporate practice , RVU counts , the increased “ efficiency ” of medical practice , replacing much of what we trained to do with mundane tasks which could be done by those with much lesser skills and training and education . At the same time , however , those with much less training , education and without the benefit of a medical degree are attempting to replace us as physicians under the guise of expanded access to care .
Yes , their results overall are about as good as the care provided by a physician ( as they like to point out ), but that is simply because most minor ailments are self-limited anyway ( which is why charlatans , witch-doctors , and snake oil salesmen of all ilk have been so successful through the ages ), and no matter how little you know or do , most of their patients will have a good outcome . That becomes more complicated , however , when those with incomplete education or training have the ability to order tests or procedures which , in addition to being expensively unnecessary , carry a risk of complication or injury , as well as additional strain on an already overburdened family ’ s medical budget . It ’ s only those who really need our full education , training , experience and dedication who truly benefit from seeing a physician . In those relatively less common encounters in which that extra bit of knowledge , experience and insight make the difference in distinguishing a serious illness or condition from its minor , self-limited doppelganger , the mid-level practitioner is insufficient and a danger to patients .
Now , increasing pressure on physicians to produce more and more for less and less reimbursement ( and therefore greater profit to the “ not-for profit ” institutions which hire them ) results in less time to really evaluate patients . Think about the myriad of possible conditions they represent , and truly give insightful thought to the best approach to their individual problems . Add to this the additional work required ( as well as the difficulty in finding the meaningful and important information ) in the electronic medical record systems we now all have to endure , and the result is too little time to adequately care for the patients in front of us .
Fortunately , since most of those conditions are not life-threatening and many will resolve on their own , most patients have acceptable results . In corporate medicine , the PR types of concerns - whether parking was validated , or they had to wait in an uncomfortable chair , or read an outdated magazine while waiting , or a myriad of other Press-Gainey issues having nothing at all to do with the actual quality of care delivered - can become a major issue for the physician being evaluated .
Unfortunately , however , patients do suffer at times as a result of this system , either in terms of missing a diagnosis , rushing through a biopsy , not spending adequate time reading or reacting to an imaging report and the subtle wording within it which , had attention been paid , would have alerted the physician with time to absorb it to a malignancy which might otherwise be missed .
I have seen this occur , as have many of you , in the past . Now , however , it seems to be much more common . Ultrasound reports are misinterpreted and not integrated into the overall care plan of a patient . Lab reports are formatted differently , so a seriously abnormal result gets missed because of the new nuances within them . Since there is no
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