Stanley Feld M.D.,FACP,MACE
Our present healthcare system is driving both patients and physicians away from what they need in caring for a patient’s illness.
Medical care is being forced into becoming a commoditized industry. Every step in medical care must fit into a protocol in order to be reimbursed. This is true for private practice as well as healthcare systems in which physicians receive salaries from the institutions.
It is commonly believed by the public that these physicians have no incentive to be productive. This is a false perception. If these physicians are doing direct patient care daily the unit manager’s job is to push the physicians to be productive and generate income.
Many of the salaried physicians are not motivated to develop a relationship with the patient because they will not see them again.
A complete history and physical examination is the first thing future physicians are taught in medical school.
If a physician lets the patient tell his story and it is followed by a complete physical exam, a physician can make a diagnosis 90% of the time.
Economic pressures have bastardized the system of complete history and physical. Physicians do not have time to develop a physician/patient relationship.
Dr. Abraham Verghese TED talk : A Doctor's Touch says it all. Everyone who is interested in what happened to medical care and a physician/patient relationship should watch this You Tube.
The physician/patient relationship is the desire of many patients. This is one of the reasons for the growth of concierge medicine practices in the country. Physicians have enough time to spend with their patients. The upfront concierge fee subsidizes the physician’s income. Physicians have enough time to perform a complete history and physical.
I was talking to a retired internist this last weekend about Dr. Ezekiel Emanuel’s pronouncement about the yearly physical being worthless.
He said that was crazy. His yearly physical saved his life three different times over a thirty year period.
The first was the discovery of his cancer of the prostate. It was picked up on his yearly physical.
The second time was when leaking of his mitral and aortic valve was discovered on yearly physical. It resulted in valve replacements.
Third time his life was saved on another yearly examination was when a mass found in lung on a chest x-ray during a routine annual check up.
He said he would have been dead long ago if he did not have an annual physical.
It is easy for a politician or policy wnk to say something is worthless if he is not the patient.
This example is further evidence that government should not be responsibile for the patient's healthcare dollars and make the patient's medical treatment decisions.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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