Let Doctors be Doctors

It’s a strange business we are in.

Doctors are spending less time seeing patients, and the nation declares a doctor shortage, best remedied by having more non-physicians delivering patient care while doctors do more and more non-doctor work.

Usually, in cases of limited resources, we start talking about conservation: Make cars more fuel efficient, reduce waste in manufacturing, etc.

Funny, then, that in health care there seems to be so little discussion about how a limited supply of doctors can best serve the needs of their patients.

One hair-brained novel idea making its way through the blogs and journals right now is to have pharmacists treat high blood pressure. That would have to mean sending them back to school to learn physical exam skills and enough physiology and pathology about heart disease and kidney disease, which are often interrelated with hypertension. Not only would this cause fragmentation of care, but it would probably soon take up enough of our pharmacists’ time that we would end up with a serious shortage of pharmacists.

Within medical offices there are many more staff members who interact with patients about their health issues: case managers, health coaches, accountable care organization nurses, medical assistants and many others are assuming more responsibilities. We call this “working to the top of their license”.

Doctors, on the other hand, are spending more time on data entry than thirty years ago, as servants of the Big Data funnels that the Government and insurance companies put in our offices to better control where “their” money (which we all paid them) ultimately goes.

In primary care we are also spending more time on public health issues, even though this has shown little success and is quite costly. We are treating patients one at a time for lifestyle-related conditions affecting large subgroups of the population: obesity, prediabetes, prehypertension and smoking, to name a few that would be more suitable for non-physician management than hard-core hypertension.

It is high time we have a serious national debate, not yet about how many doctors we need, but what we need our doctors to do. Only then can we talk numbers.

4 Responses to “Let Doctors be Doctors”

  1. 1 Philip G Miler Md April 19, 2014 at 2:04 am

    Need to keep speaking up, hoping we reach a “tipping point” where some rational approaches will be incorporated into this “health care delivery” mess. While waiting on the moral and rational Single Payor to arrive.

  2. 2 Bariatric Help April 19, 2014 at 1:34 pm

    How about getting doctors to carp on displaying office managers and higher up admins (plus hospital lawyers) AND insurance company middle management and up, and publishing their salaries? I took a look at sorts of doctors pay I’ve had or know on the Medicare salary data and went … what’s the big deal? I saw a lot of complaints over nothing. You’ve got some outliers out there that need checking out, but as a whole, whooptie do, you know?

    The profession would have been better off by asking the groups above to disclose their salaries or working on fixing rates of misdiagnosis and delayed diagnosis, which would have a bigger effect. Or both.

  3. 3 Catherine Morgan April 19, 2014 at 3:03 pm

    My doctor doesn’t look at me nearly as often as he looks at his tablet, or pad, or whatever electronic gadget he uses. I get the feeling that I, as a person, am not as interesting or important as the data in which he is so absorbed.

  4. 4 Janine Calder April 21, 2014 at 4:51 pm

    Bingo, Catherine Morgan.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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