I had a patient today who brought his wife who doesn't want to have a primary care physician. She has one now, but doesn't like him. She wants to see me for a neurological issue, but she wants me to "be her doctor". She doesn't want a primary care doctor. This is the third person this week who had this sort of discussion with me. One patient told me that his cardiologist told him he doesn't need a primary care doctor.
A lot of the "primary care" doctors are starting to refer the patients to specialists for almost every concern that comes up. They are also not seeing patients urgently. They send the patients to the "walk-in" clinics or "urgent care" centers. They also don't care for the patients in the hospital, because we have "hospitalists" now - physicians who specialize in the care of patients in the hospital.
The Walmarts and Publixs and CVSs are starting to have clinics with Nurse Practitioners and Physicians Assistants attached to the pharmacy. In Hawaii, they have started ten minute computer-interface physician "prescribing consults". You never actually see a doctor, you just communicate via computer to get a medication.
We are creating greater and greater efficiency in everything. The "encounter" with the patient is now an "event" that can be quantified and expedited to the point that there are physicians who see eighty patients a day! Today, I saw eleven patients. I am clearly not getting the point of it all. (I know a way to increase my income 7.3 times, though). This is great efficiency. I am not good at "primary care". I don't do it all of the time. I didn't train in it. I tell people this. I do think that there are other people who do it far better than I ever can. The problem is that the patients don't care that much about what you're doing if you don't care. They can't get past the fact that you don't care. The problem is that if you care, you can't see eighty people a day, and it isn't efficient "enough".
In the great rush the "primary care" physicians are rushing themselves out of a job. I don't even know what to say.
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2 comments:
Doctor, it's not only your extensive knowledge that make you such a great doctor, it's your caring attitude. I'm sure all of your patients, and their care givers, leave your practice knowing you care. Your take-home income may not match that of some doctors, but I'm sure you sleep better at night.
Thank you for caring!
Here is a view you may have interest in. We live in a culture that does not really meet what is best for us. There is no tolerance for anticipation. The skill of waiting has dissolved over the years. Immediate satisfaction is needed. If it is not obtained, there will be retribution from those who are faced with waiting and consequences for those who created the wait. If one gets sick, they cannot wait, they must be seen right away, no matter what. They are to be squeezed into the schedule or something has to be changed so the schedule can accomodate the one who cannot wait. The skill of waiting has been lost. Entitlement has taken over and punishment will follow those who get in the way. Maybe there are 80 patients on a schedule because those 80 cannot wait. Maybe some of those 80 were "squeezed" in. Maybe some of those who were squeezed in demanded more time then customary, even if enough time was alloted. After all, the battle to treat the illness of "immediate satisfaction or else" was treated once the physician walked into the room. Now the patient can relax leaving little room for the idea that there are 79 people wating for their turn. That is not their problem, it is their turn to see the doctor and they want to be treated as though they are the only patient and they should be. I would imagine that specialists are a gift to the primary physician. They can keep the visit short and tag team a specialist. That way, the patient never has to wait. There is always a doctor somewhere who will be able to see them and satisfy the anxiety that is commonly attached to the original illness. Please do not think for one moment that I say these words lacking compassion for patients. I do not. However, I read what you wrote and thought if I could see another view, it would help. Maybe not...
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