Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Tuesday, July 2, 2013

The Culture of Medicine and the Art of K'vetching

I've been reading a lot of professional posts and articles, lately-one perk of writing a blog is that it forces me to read up on topics. A lot. The kind of reading up that should count towards MOC, and not just as Category 2 credits.

But I digress.

What I've been thinking about is, "How did we get to this place?"

The DSM, pick a version, tells us how to diagnose, assuming we want to be paid, or our patients to be reimbursed.

The APA tells us we have to change the way we code billing and to change the way we write our notes accordingly, even if that means said notes cease to reflect anything about the treatment.

I-STOP tells we have to stop in the middle of a session, get online, and check to see if the person sitting in front of us is misusing controlled sbstances.

The ABPN, endorsed by the APA, tells us we have to pay thousands of dollars to take exams that cover outdated meds and topics, and additional money to waste time doing PIP modules that intrude on patient care, encourage checklists rather than talking with patients, and have never, not even remotely, been shown to improve quality of care. And if we don't do this, we will lose our board certifications, and possibly our licenses, down the line.

HIPAA tells us we have to ask our patients to sign forms indicating they know we're sending their private medical information all over the place (See What, Exactly, Is HIPAA?)

The government tells us we have to implement expensive electronic medical record systems that are designed for billing rather than patient care, that send private medical information willy-nilly into the cloud, that take time away from patient care, and that have not been shown to improve quality of care.

Insurance companies tell us how and for how long we're supposed to treat our patients, and I don't care that they pay lip service to the idea that all medical decisions are the responsibility of the doctor/patient dyad, and not of the companies holding the pursestrings.

Politicians tell us we have to compromise our patients' trust by reporting them to a national database if we think they might, at some unspecified time in the future, be dangerous, and that this will help prevent the random and rare wonton murder of school children.

This is crazy! How did we lose control of our own profession? I mean, I don't go around telling lawyers how to practice law!

Here's a link to a thoughtful post by Dr. James Amos entitled, Can We Make Medicine More Fun?

Given everything I've just written, I don't see how.

In considering where this all comes from, it seems to me that it has to do with the "Suck It Up" attitude that exists in medicine. You have more patients than you can safely manage? Too bad! You need to work 30 straight hours without sleep? Tough! You need to fill out an ever-increasing number of meaningless forms? So what! You need to be in two places at once and do more work than is humanly possible? Suck it up!

There's no getting away from the fact that part of medical training involves learning to do what you're told without complaining, even if it makes no sense and requires magical abilities, because it's for the good of the patient.

This attitude might be just fine if it actually were for the good of the patient. Maybe it used to be, but not anymore. Our complacency has harmed our patients. All these external requirements amount to diminished care.

Here's what needs to happen: We, the doctors in the clinical trenches, need to break out of our well-trained molds and learn how to k'vetch, good and loud, and not just to each other, like I'm doing right now. And we need to refuse to let people who have no medical training or experience tell us how to do our jobs.

How do we go about this?

What do you get when you cross an elephant and a rhino?