Friday, Mar 13, 2009

Paradigm Lost

Today's Lunch Break:
http://bits.blogs.nytimes.com/2009/03/10/using-technology-to-skip-the-doctors-office/

My grandfather, a retired pediatrician who shares my first and last name, speaks fondly about going on house calls, black doctor bag in hand, to checkup on children and calm worried parents. In the past few years, I have run into multiple people who, upon recognizing our shared name, speaks of him in glowing terms like "my doctor" or "our pediatrician." My grandfather says that such relationships were the most rewarding aspects of his career.

Like my grandfather, I expect much of my satisfaction as a physician will come through direct interaction with patients--email, phone, office visit, house call, whatever form it ultimately takes. On my mission, I spent much of my time in regular, intimate visits with individuals and families. Many were wanting to make lifestyle changes, such as overcoming addictions, and were often very open despite my being almost a complete stranger. During our visits, as I listened to their fears and doubts, I developed for them a kind of love that I had not experienced before. I expect medicine to be similar.

I realize, however, that such satisfaction will not be guaranteed. It only takes a quick web search with the terms "physician disillusionment" to realize that there are real challenges facing doctors today. My greatest fears as a physician include being caught in a situation where I am bound by the dictates of an insurer and not the available best evidence and my own conscience--or worse, I fear that my idealism will sour into cynicism amid a daily grind of paperwork battles, malpractice fights, and business decisions. Even my grandfather has noted the changes to the health care system with managed care and wonders if he would still choose medicine, were he and I to switch places.

How do we fix health care? That is the million dollar question...well, no actually, it's the two and a half trillion dollar question [1].

We're not short on solutions. Today's featured article, as an example, points to the merits of the use of secure email and electronic records, as evidenced by doctors in Hawaii. In the age of Google and Facebook, this idea seems incredibly obvious--and frankly, a bit shocking that it is newsworthy at all. But sadly, this simple, small innovation is made nearly impossible by the present "fee for service" paradigm that doctors find themselves in.

I'm glad that health care reform has remained in the public consciousness and in the current administration's agenda. Hopefully when I'm done with medical training--nearly a decade from now--I won't have to deal with the worst of our current problems. In the meantime, you'll probably be hearing a lot more on this subject from me.

[1] And it's not paying off.