Reflections on medicine from a duly registered and certified curmudgeon

February 10, 2017

So much garbage. So little time.

Thoughts of setting fire to my desk appeared in a lovely cloud above my head. Hovering gently, they lingered.

My inner curmudgeon raged, urging me on.  

“Do it!” Do it!”

So much garbage. So little time.

 

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An efficiency expert that I once knew suggested that I burn, shred or pour molten chocolate all over the junk on my desk. In this way, I could gaze upon a cleared, if somewhat charred and smoky-smelling desk. 

I mused, wondering if there was really a desk underneath it all, or just masses of paperwork, pre-authorizations, denials, PQRS reminders, HIPAA notifications, OSHA mandates, Medicare Recovery Audit Contractor information… all just piled there with no desk beneath it.

If something was important, such as a bill, it would reappear next month with a friendly reminder. And the other stuff would reappear next month, too. Good advice.

Armageddon, my superb office manager, tried to help. She had organized piles. A red poster sheet highlighted with pre-authorizations. There was a green one: Prescription refills. The blue pile cried out: Absolutely necessary studies denied by the absurdity of insurance companies that don’t give a darn about the welfare of our patients, and I will get their peer entities on the phone and waste time, but the patient will have what he/she needs.

Ah, Armageddon, you know me so well.

 

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I am Doctor Curmudgeon.

I have been practicing medicine since the Pleistocene Era. I yowl at injustice, wastefulness and the lack of concern for the health of my patients from all those Powers That Be. And I can remember the good old days when I had nothing to worry about except my patients and keeping up with what was going on in medicine. Sheer bliss. Little did I know that things would change and I would become Doctor Curmudgeon.

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How can I deal with all this claptrap, these obstacles in the way of my patient and me?

First of all, to keep hitting the same note: My patient care is my first priority.

To do this, I ignore meaningless use. For me, it is truly meaningless and wastes precious time that I could be spending with my patients.

New patients are given a full hour. If I do not know them, I need time to do a complete history and physical.

 

Further reading: Should doctors extend their practice hours?

 

Returning patients are booked on the half hour. I need time.

We were forced into an electronic health record (EHR). This entity creates errors in and of itself. So, we also keep a printed copy of the progress notes in the chart. This is printed out and as I face the patient, I scrawl notes on it. For new patients, we have a form printed out which has:

 

Name

Chief complaint

Past history

Review of symptoms

Social history

Physical exam

Plan

 

On that form, I scrawl my notes, all the while facing the patient, making eye contact, noting posture and all those clues that I was taught to observe while a fledgling medical student and not yet a curmudgeon. Then, at noon, I transcribe these notes into the EHR. If there are hospitalized patients, my partner makes rounds while I complete this task.

 

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I stay at the end of the day to transcribe the afternoon notes, and return non-urgent patient calls, such as lab results for those who are unable to return in person.

Next: The horror of QPP

 

I was once asked what I did. There are times when I think I am just a data entry clerk…thanks to the EHR.

We request that patients return to discuss lab work and studies. This actually saves time as I find myself playing that old game of “phone tag,” and thus, more charts take up space in another pile.

 

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Medicare’s new Quality Payment Program-this horror made me reach for chocolate. It is beyond the ken of a curmudgeon. This is not helpful to others who may read this, but I cringe at all the acronyms that have been heaped upon us. My serum chocolate level rises as I calm myself using my favorite food group.

I have always despised most acronyms. Most of them seem to be cover-ups. Groups of letters created to hide something. PQRS! What on earth?  Good medical care cannot be measured in metrics. I ignore them.

Not helpful, I know. But that is how I deal with it. Auditors who have looked at my records say that I am actually accomplishing all of this, just by being the kind of curmudgeonly old doc that I am.

But when I close the door to the exam room, and sit down with my patient, I feel at peace. This is why I am here. It is like going on stage. All the crud, all the garbage, all those trying to get on my back and tell me how to practice medicine…gone…left behind in my messy dressing room.

I am doing what I love.

I am here with my patient…doing the best that an old curmudgeon can.

For all those powers that be, the bottom line is profit and denial of care.

For a curmudgeon, the bottom line is patient care.

I am proudly a curmudgeon who will give the best care that I can to my patients and that is that!