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Physicians must combat healthcare changes with professionalism


The business of medicine has drastically changed over the past 20 years.

Washington, D.C.-The business of medicine has drastically changed over the past 20 years.

Banu E. Symington, MD, FACPElectronic health records, quality metrics, telemedicine, population health and the Affordable Care Act are only a few examples of the changes physicians have had to tackle in the last decade alone.

Regardless of how physicians feel about the laundry list of healthcare developments, one thing is certain-innovation brings unintended consequences to doctors, says Banu E. Symington, MD, FACP, of St. Luke’s Health System, Twin Falls, Idaho.


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That is why she-along with Omar T. Atig, MD, FACP-will be discussing the important topic during this year’s American College of Physicians Internal Medicine meeting in Washington, D.C.

Their panel discussion, “Ethics Year in Review,” will take place Thursday, May 5.

“What is new and appears innovative is likely to be imperfect and cause a new set of problems,” says Symington, who is also governor of the American College of Physicians-Idaho Chapter.


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While physicians may balk at much of these changes, they must proceed with caution and professionalism, she says.

According to Symington, there are four areas in which physicians should take away from the session:


·      Employment contracts

o   Contracts with a physician’s place of employment could limit the physician’s ability to protect patients “by preventing physicians from speaking out about hospital quality problems, (EHR) problems, and by forcing in-hospital referrals to potentially less well-trained specialists” as these would quality as a violation of anti-trust laws, Symington says.

Next: Be careful what you ask for...


·      Quality measure precautions

o   Mandates for quality measures may result in worse care, she warns. “Quality measures have only been demonstrated to improve care in a handful of medical diagnoses,” Symington says. “Meanwhile, the preoccupation with quality check boxes takes time and attention away from the living, breathing patients in front of you.”


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·      Patients are not cars

o   Referencing the Toyota model, Symington says efforts to employ patient care in that company’s management style can result in suboptimal care. Fixed time encounters-particularly because of EHRs-limit open-ended history taking, as well as time for the physician to adequately review and integrate the data to come to a diagnosis, she says. “Patients are not cars. There are many genetic, environmental and physiologic factors that lead to the need for individualized care.”

·      Focusing on patient volume can lead to scandal

o   “Demonstrated in both the UK and the VA system, where high expectations with inadequate staffing led to the creation of ‘fake’ patient appointment times,” she explains.

Despite the ever-growing challenges physicians are facing, Symington says it is crucial doctors tackle these difficulties head on and keep focusing on the preservation and promotion of heath and safety to their patients.

“With all changes, these have unintended consequences,” she says. “Be careful what you ask for, and be careful how you implement changes.”





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