Before you think I'm jaded, let me share a little perspective. Some years ago I was an undergraduate, working as an Emergency Medical Technician in a rural emergency room, a bright-eyed aspiring doctor to be. During a break in the action of a long night shift I was chatting with the MD and he asked me point blank “why do you want to be a doctor?” I was caught by surprise, and I mumbled something about helping people in need--isn't that the only real reason to go to medical school?
The MD looked me straight in the eye and told me,
“if you want to practice medicine, go to law school.”
Life changes, as life has a way of doing, and I never attended medical school after all--I earned a graduate degree in chemistry and I am very happy with my choices. But thinking back on that conversation, I think the doctor was right.
Over the years I have seen an erosion of the doctor-patient relationship. A morphing into some strange new creature, the doctor-insurance-DEA-patient relationship. When I was a kid, your mom took you to the doctor, and the doctor would spend some time getting to know you. Through unhurried conversation, they would take down a detailed history, in order to understand your medical concerns, discuss treatment options and you would leave to pursue the course of treatment.
Fast forward to today. Think really hard. When was the last time you experienced this?
Today doctors work more for the insurance companies (and their lawyers) than for the patients. Insurance companies dictate which treatments will or will not be covered, regardless of the wishes of the patient and the doctor. Insurance companies also control ever reducing reimbursements, while the cost of medical practice increases. To have profitable medical practice doctors must see on average of 5 to 6 patients per hour. If your doctor appointments are anything like mine then your recent visit to your family physician involved a technician taking vitals and asking routine questions. The doctor then came in, talked to you briefly while reading the notes, listens to your lungs, renews your prescriptions and is off to the next patient in under five minutes.
Why the shift in the patient-doctor relationship?
In today’s world, doctors have additional groups to worry about, such as the DEA and the Medical Licensing commission. To put this section in perspective I admit that even 25 years ago I saw my fair share of patients coming into the emergency room seeking narcotics. Some may suffer real pain while others were known to frequent area hospitals in search of narcotics. One of my softball friends related a frustrating interaction he had with his doctor recently. For the past 3 years, his doctor gave him Vicodin for occasional pain. In any given YEAR he would take 25 to 30 pills. During his last checkup, his doctor says he cannot prescribe Vicodin anymore. In order to obtain another prescription, he needs a referral to the pain clinic where they are likely to offer other treatment options and may or may not prescribe narcotics. If they do prescribe narcotics he would need to sign a “drug contract” and submit to at least two drug tests a year. The end result is that the doctor who knows the patient best is powerless to offer the treatment of choice.
Other than wasting time and resources what exactly is being accomplished by the persecution of doctors who try to treat patients with controlled substances, all it does is increase healthcare costs. Will it stop the abuse of controlled substances? or worse prevent doctors from prescribing beneficial treatments when warranted?
The influence of lawyers and legislation in medicine is considerable, but as medicine and technology race ahead, caution is warranted. Patients and their needs should come ahead of mindless adherence to laws that were made by politicians. After all, I wouldn't ask a doctor to draw up my will, I don't need a lawyer directing my medical care.