In medicine, time is muscle during a heart attack and time is brain in case of strokes. Thus time is health and health is wealth. And so, time is money. We are running out of both. As we patiently watch, critical access to medical care gets inaccessible, meaningful use of electronic medical records gets meaningless, life saving drugs cost more than saving lives, doctors need doctors more than ever before, sickness is no longer limited to the patient but has metastasized to the system, and moral compassion has been replaced by immoral passion – for power, money, and commodity. Our healthcare is being deviously stolen by the financial elite whose wicked exploitation of private enterprise has been surreptitiously chipping away at the overarching mission of the medical community to provide high quality care with kindness and empathy. In fact, you could call it downright theft.
In recent years, as doctors are compelled to spend more time with computers than with patients to justify their care, the cost of healthcare has escalated to never-seen-before levels. Historically, doctors have been notorious for their indecipherable handwriting. It has made them a target of ridicule as well as alleged perpetrators of medication errors. Well, that problem has apparently been resolved, at least in the United States! Or so it seems.
With federal regulations implementing the mandatory transition from paper to electronic medical records in all practices and healthcare systems, doctors have discarded the pen for the mightier keyboard. ‘Meaningful use’ diktats have taken the digital transformation to a whole different level, under which almost a dozen requirements have to be fulfilled for each clinical note to satisfy the reimbursement prerequisite. Doctors are continuously being pushed into a corner by the demands of legal protocols and technology and they have been forcefully obliged to alter their daily workflow. This has drastically distorted the core nature of their profession unlike any other line of work – to care for people in a compassionate manner. We now type notes to get paid whereas we used to write prescriptions. Ironically, the physician note remains indecipherable, though not due to poor handwriting but due to the nature of the electronic components that result from countless clicks and templates. In a nutshell, for a 20-minute appointment, we get paid a whole lot more if we spend 15 minutes typing on the computer and 5 minutes with the patient than the other way round.
Eye contact with patients has whittled down to a few hurried glances, as providers pound away at the keyboard trying to capture as much information as they possibly can within a few minutes. The physical examination is a joke. The overall quality of care is sliding to dangerous levels. The training of students and residents has become a factor of technology knowhow rather than textbooks. Though medicine is a science, there used to be an inbuilt art in being a doctor – the art of history taking, the thorough physical examination, the eloquence of the clinical note, the deep intangible connection between the patient and physician that was beyond words. This art has somehow been lost in the digital world. ‘Cut paste’ are the new buzzwords that have become as critical for survival as the air we breathe. ICD-9 codes, a universal classification system for diseases, are being replaced by thousands of new ICD-10 codes. Indeed, these days doctors have to unlearn an enormous amount of what they know, to learn an equally enormous amount of what they don’t know, and in all fairness should not have to learn. If given the choice, most doctors would go back to old times when they could peacefully sit down with patients and chat about their health, so that we could do what we were meant to do – heal people physically, emotionally, and spiritually.
Only time will tell if we can continue to successfully be providers of compassionate patient directed care or whether robots will replace us in future, to dispense precisely modeled cures without the human element. Maybe the new generation of men and women will be so clued in to technology that they may be impatient with the human touch. After all, decades of relentless reading from books and arduous training to become a doctor could, perhaps easily, be fed into machines that could provide the kind of impassive and deadpan care that we are currently providing. And after an initial investment, we wouldn’t even have to pay them for their services! The best part? The clinical note would be mutually comprehensible and legible to the androids.
Special request from Dr. Pandey: If your experience at the doctor’s office has changed with times due to technology please share with us. Perhaps the declining patient experience may force the regulators to rethink what they are doing to healthcare.
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