Dear Doc H:
Q: I just moved my aging father to live near me. To establish medical care I scheduled an appointment for him at a local medical clinic. After filling out what seemed like an unnecessary number of legal forms we saw the doctor for maybe about 10 minutes. He spent that time asking a few questions, but mostly typing into a computer. He barely even touched my Father. He ordered some tests, made some referrals, then he was gone. What ever happened to Dr. Marcus Welby? — Signed Disenchanted
For those of you too young to know, "Marcus Welby, M.D." was a show from the '70s about the quintessential general practitioner, the doctor you’d want taking care of your family.
Welcome to the new world of medicine and your new doctor is not to blame. Your doctor decided on a career in medicine because he genuinely wanted to help people like your father. But, the poor physician is so shackled by rules, regulations, litigation risks as well as governmental and insurance oversight that it’s all he can do to care for your father. Caring for people is why he went into the field, but regulatory agencies have made his job close to impossible, certainly impersonal. His new job is not so much patient care as it is documentation. The sad part of this is, medicine will eventually become a less favorable career choice and the “best and the brightest” will stop applying.
What changes have occurred:
Like many things in life, ideas that were once valid and well-conceived eventually morph into monsters, creating regulations which instead serving their original intentions, produce roadblocks, worsening the very issues they were designed to improve.
Let’s look at just a few examples:
You have free articles remaining.
EMR’s (electronic medical records) – The idea here was that a patient’s medical record would always be available and easily accessible to any physician or institution anywhere, anytime. They would also be green, saving on paper waste. The problem is EMRs become so overly burdened with insignificant data that it becomes hard to separate the wheat from the chaff. Does it really matter that problem No. 31 was a bunion on the left large toe in March 1981? Doctors used to document their findings in what was called a SOAP note (subjective, objective, assessment and plan). This one short paragraph documented all that was valid from the interaction. But, even these notes started requiring higher complexity to protect against the looming threat of frivolous lawsuits which were becoming increasingly common. More time dictating or typing = less time for the patient. And as for greenness? With EMR records there is actually far more paper waste given the complexity of these documents as paper transfer never really went away. Enormously expensive EMR systems also add hugely to the cost of providing medical care. If your doctor must see more patients to pay for these systems it means less time with your dad. Although there may be some small advantages to these systems the risks of data breaches, errors in your record that are impossible to correct (think your credit report), complexity, cost and erosion of the doctor/patient interaction really make the EMR far from ideal.
Health insurance: Your insurance company now dictates who you can see, what tests can be ordered and how you will be treated. Oddly, most care decisions, whether they be for surgery, tests and now often medications, are made by people with very little if any medical background. Your doctor and his staff will spend substantial amounts of time “asking for permission” to treat you as they have been trained to do. Again, we are reducing time your doctor can spend with you.
HIIPA laws: As the electronic transmission of medical information became more commonplace laws were passed to ensure patient privacy. The law may protect against an aberrant email or faxing errors, but provides little protection against large security breaches which are the biggest risk to the EMR. This is the law responsible for the endless forms, seemingly the copy of War and Peace, you must sign each time you establish with a new doctor. Your doctor must assure HIIPA compliance to the letter or face stiff fines. And this law continues to evolve, adding restrictions that make very little sense in the name of patient “privacy”. One example is that regulated set back tape line at all pharmacies. Uh, that’s private. How about a cone of silence? Also, if you need to find a patient’s family to tell them how little Billie did with his tonsillectomy, forget it, as hospital paging with a patient’s name is now taboo.
So, is Dr. Welby gone forever? Well none of this is the fault of the fine people that are caring for you, be they your doctor, nurse practitioner or physician’s assistant. They are doing the best they can while being shackled with these new mandated regulations. So with all these changes that are occurring are we healthier as a species? I’m going to submit that we are not. It seems that Millennials will be far less healthy than their parents. And there is more and more money coming out of the pockets of the sick than ever before. The sad part of this is, things always get worse before they get better. Still, there is already some backlash from physicians against the more ridiculous rules. Over time things always seem to settle out somewhere in the middle. Ideally, over time your doctor may eventually have more control again.
So, will Dr. Welby ever hang out his shingle again? Probably not. And as for Dr. Welby’s son? Well, he has a YouTube channel.
Dr. Charles Hurbis is an ENT-otolaryngologist has been practicing in the Bay Area since 1991. His areas of interest/expertise include the diagnosis/treatment of sinus disease and nasal airway issues, treatment of skin cancer, sleep medicine, facial plastic surgery as well as the other spectrum of head and neck disease.
Dr. Hurbis's practice is located at 2695 N 17th St. in Coos Bay. 541-266-0900