Some of the most important qualities that patients look for in their primary care doctors are rapidly disappearing. Things like time for talk and compassion, and kindness and trust.
It’s not that physicians don’t care about the value of these qualities. Most of them know that in addition to a solid knowledge of medicine they are indispensable to providing good primary care. Knowing that patients want and deserve the personal touch is what drew them to choose a career in primary care in the first place.
But now that insurance companies are competing with doctors on how to practice, they have overrun the profession with regulations. The regulations pretend to cut costs but I suspect they are mainly used to increase insurers’ profits. Complying with these regulations is a serious and time-consuming distraction. Doctors find that they have less and less time to talk with patients and to do a good examination.
What are some of these distractions? Well, primary care doctors often have to seek approval from an insurer to get a consultation or prescribe a medication. These interruptions occur throughout the day. They frustrate the doctors but the receptionists and the nurses also get discouraged. And, like the doctors, maintaining a friendly attitude becomes a real challenge for them.
The intrusion that doctors despise the most, however, is the pressure to record patients’ data electronically on computers. Until recently, doctors would routinely record office visits in the patients’ charts by writing them by hand on paper while talking face-to-face with their patients. It was a time to re-discuss problems and continue a friendly conversation.
But now physicians are required to record the visits electronically. The concentration on inputting the information correctly on the computer keyboard is intense and the connection with patients is lost. In fact one of the most common complaints that patients bring to me is that they feel that their doctors spend more time looking at the computer and plucking away at the keyboard than looking at them. Who can blame them for feeling that the health system is passing them over?
Unfortunately, primary care doctors are unduly burdened by insurance companies’ policies. This is perhaps the biggest problem in medicine today. It is the main reason why fewer doctors choose primary care as a career. Yet, it is to their primary care doctors that patients go to first for advice on such things as whether to go ahead with a knee replacement or how to approach a personal problem.
There is no easy answer to these problems facing primary care practices. Because the business side of medicine has gained the upper hand in controlling medicine, it has become almost impossible for small primary care practices to survive. The financial burdens of complying with the many new regulations are hard to overcome and many primary care doctors are joining hospitals and leaving the administrative work to them.
When I mentioned these complaints to a colleague he thought that in the future, primary care doctors might have robots doing the administrative work and filling out all the required forms. Then they would have the time to slow down and talk to patients and show empathy and kindness and, gain their trust.
I think there is more truth than humor in his words.
Dr. Edward Volpintesta has a practice in Bethel.