For almost 20 years I practiced Ophthalmology and geriatrics in my own office. I had tens of thousands of face-to-face interactions with a group of folks who, with time, grew to trust me. I respected them as well; many I came to love — a term that I hesitate to use in this hypersensitive age. Given how geographically dispersed families are today, for many of my older patients I functioned as a surrogate son.
Things began to change abruptly in 1989, as HMOs, capitated reimbursement, as well as a flurry of eponyms guiding how medicine should be practiced.
There is no doubt that the kind of medicine I was fortunate to practice is disappearing. Most doctors are employed by large group practices, hospitals or insurance companies. Many want to have personal connections with their patients but have too little time. Young primary-care doctors are relegated to assembly-line clinics; their patients pass through as widgets, not as individuals with complex inner lives, wrought family structures, varied spiritual and cultural beliefs — not to mention their individual capacities to understand and deal with their medical symptoms, diagnoses and multiple medications, as well as their own hopes and fears.
There is no doubt that the kind of medicine I was fortunate to practice is disappearing. Most doctors are employed by large group practices, hospitals or insurance companies. Many want to have personal connections with their patients but have too little time. Young primary-care doctors are relegated to assembly-line clinics; their patients pass through as widgets, not as individuals with complex inner lives.
Physicians are now insulated from knowing too much about their patients. It is all about the technology, the testing, the imaging, the electronic health record, the data — once collected by the doctor, but now so regulated and overwhelming that paramedical professionals have been enlisted to record the so-called minutiae, the often rote information in which may lie important clues. Some of these may remain forever buried, the patient not wanting to share sensitive details with just anyone, especially someone who no longer makes eye contact, whose face remains buried behind a computer screen, who seems uninterested or just unskilled in reading body language — that downward glance, that shift in the chair, that half-swallowed response.
(Original translation from the Greek)
The art of being a physician has disappeared, and also the art of being a patient, replaced by EMR, patient portals, mobile health devices. All of this in the 'name' of being more efficient, caring for more patients, and to yield data for the government and insurance companies to manipulate using algorithms derived from 'big data' and analytics.The relative isolation of medicine as what was called a 'cottage industry' had a secondary purpose, one often not recognized. The ability for physicians to make decisions in private, and protection of patients. Although HIPAA strives to set a standard to protect patient information, it does not. Physicians practice medicine according to the Hippocratic oath which contains the following phrase.
"I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humility and awareness of my own frailty. Above all, I must not play at God."
(Modern version)
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humility and awareness of my own frailty. Above all, I must not play at God.
Note that the two versions are identical. Despite centuries of existence our oath remains unchanged, while the world around us has changed. It seems to parallel the existence and intepretation of the U.S. Constitution set forth over 250 years ago. Today we alter the foundation based upon our present day needs.
For my younger colleagues, who ask, "What was it like to practice medicine in your day ?" My answer is "the patients are the same, the treatments are better. Isn't science wonderful ? " The Creative Destruction of Medicine.
In America, the art of doctoring is dying - The Washington Post
No comments:
Post a Comment