Medical care is in the middle of significant transitions which can directly effect your quality of care, control of disease, and survival. It is time to evaluate your doctors and how they give you care.
The most important transition is the increased use of electronic medical records (EMRs). You know this, because every time you see your doctor, she/he spends more time looking at a computer screen and typing, rather than actually looking at you and examining you (there are a few exceptions, like doctors who use scribes to type what the doctor says into the computer, or doctors who don’t use computers and spend that time scribbling their notes and orders). This typing is necessary for creating a complete medical record of your visit each time so that the doctor (or her/his employer hospital or clinic) will get paid as much as possible for the visit, and so that the note and the care you receive can be compared to national standards for compliance with the best practices in your illnesses. Use of EMRs can be helpful in making sure your orders are comprehensive and legible to nurses and pharmacists and other medical consultants. But EMRs use up much of the valuable time that the doctor spends with you, rather than doctors asking more comprehensive questions and/or giving more thorough advice to you. Efficiency is often replacing compassion.
The next important transition is purchasing of medical practices by hospitals, universities or large multispecialty medical clinics; and merging of independent medical practices into large national/regional groups of doctors. Again, this trnsition can be good and bad for your care. The good is making your doctor’s practice more sustainable (without transitioning, many doctors are going bankrupt because of increasing overhead for compliance with regulations, malpractice, costs of supplies and prices of medications; and because of reduced insurance payments). Also, larger institutions can provide better supportive care for you: more nurses, assistants, and supportive programs like physical therapy and dietary consultants.
But larger institutions require more compliance by the physician with operating procedures and standards, in-service training, and most importantly for you, frequently require physicians to meet productivity targets (seeing enough patients, or ordering enough surgery, lab tests, radiology tests, and/or treatments). This can lead to physicians spending less time with you, or ordering more care than you need. Compliance is sometimes replacing compassion.
The next important transition is reduced payments to physicians and hospitals from insurance companies and payers such as Medicaid and Medicare. This has led many physicians to retire, join larger institutions, and unfortunately modify their care for patients to use much more expensive treatments or surgeries which provide higher physician or institutional compensation, compared to what the patients actually need. Compensation, income, and money are very strong motivators in an economy that is perceived by many to be excessively greedy. Compensation is often replacing compassion.
The last transition is probably the best for you. Science, medical innovation, and clinical trials have led to many new drugs and treatments being approved for use in America. You may need one or many of these now or in the future, and their more rapid development and widespread introduction into medical care is a blessing for patients facing medical challenges. But can you get them in the face of transitions in record keeping (EMRs), changes in your physician site of practice, and economic barriers to receiving the new (and of course much more expensive) treatments? Science is usually helping compassionate care unless compensation interferes.
So what can you do now in light of these transitions? Here are Doctor Cary’s tips for your medical care in the New Year.
· Be certain you have health insurance. Uninsured patients pay more for their care, usually receive less care from their physicians, and often face bankruptcy following emergency illnesses or accidents.
· Be certain you have a doctor really interested in giving you attentive and compassionate care. To help you evaluate your doctor, see my doctor rating scale in my book and website Surviving American Medicine. Your doctor should answer all your questions, advise you on all your symptoms, discuss prevention of chronic illnesses, and give you a plan for your care that you understand and that sounds logical.
· If your physician uses an EMR, make certain she/he also looks at you and talks directly to you. It helps to have another person with you (spouse, relative, or friend) to also ask questions and listen to answers. Do not be afraid to say, “Doctor please look at me and tell me exactly what you want me to do.” Ask for a copy of your visit note so you can review it at home for accuracy and whether it agrees with what you were told.
· Check the national guidelines or pathways for your condition. For example, cancer patients can look at the National Comprehensive Cancer Network (NCCN) website (it has a section specifically for cancer patients) for national guidelines established by the nation’s best comprehensive cancer centers. You can also ask your physician to tell you where the national guidelines can be found for your condition, or ask national support societies and national institutions (American Heart Association, American Diabetes Association, National Institutes of Health, and/or Centers for Disease Control). If your care does not agree with the national guidelines, ask your physician why and then consider getting a second opinion. See my book Surviving American Medicine for advice on how and where to get second opinions.
· To find out if there are newer treatments or even clinical trials for your condition, ask your doctor if there are recent treatments or medicines that can improve your outcomes. If your physician does not know, consider a second opinion at a center that is known for newer treatments and clinical trials.
· If your doctor plans to use a very expensive treatment, which seems unaffordable to you, ask if there are other options for your care or generic medicines that can substitute for expensive ones.
· To be sure that all your problems have been addressed during your visit, bring a written list of your symptoms and questions, and write down all the answers your physician gives you. Make certain you understand her/his advice and plans as well as all the side effects and costs. Never be afraid to ask, “Are these the best plans for me or are these plans just the ones the insurance or institution/hospital wants you to use for me?” Physicians may have conflicts of interest in caring for you.
In light of all the transitions in medical care, patients are having to take more responsibility for their health. Be sure you get the compassionate care you deserve.