Reflections in a Cracked Mirror

Jan 13 2016 Published by under General Health

In the past 6 months, my feeds brought me numerous articles in the medical education literature about incorporating humanism and reflection. Medical educators encourage students to ask open-ended questions and let patients tell their stories. These techniques should help create thorough, empathetic physicians who can really connect with their patients.

Of course, we then take these idealistic young things and feed them into a grinder that demands a certain level of "production." Patient visits can only last a few minutes, or we cannot generate enough revenue to keep the enterprise humming and the lights on. Increasing efficiency and productivity has worked well in industries. In healthcare, it may be counterproductive, especially when the average patient has multiple chronic conditions to be addressed at each visit.

Physicians also receive instruction now to "negotiate a treatment plan" with each patient. Instead of delivering "the cure from on high" we should take into account each individual's desires, perhaps increasing their buy-in and adherence to the plan. We can help each patient get better, even though we may fall short of the ideal outcome. Of course, the insurers actually paying for the care will grade us and base what we are paid on patient perceptions and our alignment with evidence-based guidelines. A patient may be happy with their plan of care, but it falls short of the prescribed goal of oversight groups. Will the insurer pay me based on the patient's happiness or on adherence to standards?

Is it any wonder that physicians are angry and burned out? Every day I encounter the insolvable problems of the current system. I may see a child that has a trivial lab value in my clinic. That "waste and inefficiency" in the system makes my employer very happy since it's more revenue. Of course, part of this is due to time pressures on primary care physicians. Researching stuff after a visit is unpaid work. If you make the wrong decision, you can get sued. Making that referral is fast, costs you almost nothing, and covers your ass for the future.

I have no answers, of course. This post is merely my reflection on the conflicts I see between what we teach our preclinical students and what our reality is. Think of it as my own bandage for burnout.

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