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The author resolves to practice medicine on her own terms.
I had entered medical school in 1996 with the intention to pursue family medicine; only briefly during my orthopedic rotation did I ever consider another direction. I followed my initial passion into family medicine, however, and joined a small private office in northern California. I imagined that I would remain at least a decade, maybe more. I signed contracts with a variety of insurers, not realizing that they would pay me less than the local spas charged for facials, massages, and hair coloring. At the time, I did not consider the implications of the Medicare sustainable growth rate. Since I started my practice, doctors have confronted the threat of yearly pay cuts. In short, I was naïve.
Within my first few years, three of my partners left the office to become hospitalists. With young children, family time was a priority for them. They also embraced the idea of no longer managing a business. I wished them well, while a malaise fell over me. I took a second position consulting with a local hospice to make ends meet.
Increasingly, it was becoming difficult to practice medicine in the way I was trained. My time with the patients was limited, and my enjoyment of the work faltered. I was frequently asked to compromise on the care I provided. Insurers would suddenly require prior authorizations for a medication that previously was covered. I would have to back-pedal on the plan, until I could prove that the patient had "failed" on the preferred agent. My patients frequently requested phone consults to avoid the cost of an office visit. Sadly, they were paying more for their coverage but seemed to expect less.
Patients angry over the hassles of dealing with insurance limitations would frequently direct their frustration at my staff or me. I became increasingly uncomfortable by what I considered the intrusion of private insurers into my relationship with the patients. It was not unusual for patients to decline to provide their medical history to me, fearing they might lose their insurance. In one instance, a woman with multiple sclerosis waited more than a year to tell me of this important piece of her medical background. This fear was an outrageous intrusion into the doctor-patient relationship.
"A NO-WIN SITUATION"
As the economy struggled throughout 2009, it became increasingly difficult to get paid. Numerous patients lost their jobs and their health insurance. As these folks attempted to gain coverage through the purchase of independent plans, I was dismayed to find my notes were used to deny them coverage. Patients became upset when minor arthritis, seasonal allergies, hemorrhoids, and minimal cataracts meant they would not be covered or would be charged more for a plan. It was alarming to realize that doing my job as I was trained and maintaining detailed documentation could backfire on me in this way. Patients were angry and I was too. It felt like a no-win situation.
I came to rethink my situation, however; perhaps this was an opportunity, a chance to rewrite the future of medicine.
A LOCAL INITIATIVE
With that in mind, I was excited to get involved with an initiative at our local hospital called Planetree. It is an approach to healthcare that emphasizes personalizing, humanizing, and demystifying the medical experience for the patient. The components of the model span the spectrum from providing home-like environments and foods, to the use of arts and spirituality to nourish both body and soul. Additionally, the model incorporates educational resources, involvement of family, friends, and integrative therapies such as massage or acupuncture.
The nurturing environment in this model extends to the employees and medical staff recognizing that to continue to practice care, healthcare providers need to be cared for. I have always found it an interesting irony that medicine requires the caregiver to sacrifice his or her own needs, often placing him or her at risk for burnout and apathy. Fortunately, that seems to be changing.