October 30, 2008 10:45 AM
THE DOCTOR'S OFFICE OCTOBER 29, 2008, 10:50 P.M. ET Medical Grind Hurts Healing Art
Wall Street Journal Article
By BENJAMIN BREWER, M.D.
Did you feel healed the last time you went to the doctor?
My bet is no. If you were lucky, maybe you got 10 minutes with the doctor. In not much more time than you might have spent in a fast food drive-thru, the doctor wrote a prescription, ordered a battery of lab tests and sent you off for a thousand dollars worth of imaging studies.
Somewhere along the line too many doctors stopped being healers and became prescribers and technicians.
We became business people and started thinking in terms of relative value units -- the coin of the medical finance realm -- as much as how to make patients better. We took seminars in medical coding, so we could talk the same lingo as the government and the insurance companies.
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The changes in medicine are at odds with many of the values that defined the profession I joined.
A healer takes time to understand you. That understanding leads to a more accurate diagnosis at less expense. A healer makes patients feel welcome, understood and encouraged by their visit, even if their health isn't perfect.
The right dose of empathy is every bit as important as the proper strength for a pill. I can't put my finger on a day the profession was transformed. But the change is driven home every time a health insurance company calls me a "provider" instead of a doctor. Sure, the switch in name is partly a nod to nurse practitioners and other non-M.D.s who treat patients. Yet the rise in the ranks of these alternative caregivers seems to me to have more to do with concerns about economics than about patients.
The modern physician pushes the paper around, convincing the insurance clerks to pay. The sad fact is the documentation of your visit and paperwork for referrals likely take your doctor as much time as seeing you.
As I look around I see plenty of doctors suffering from compassion fatigue. I don't consider myself a burned-out family doctor. Delivering kids and watching them grow up brings me as much satisfaction as ever.
Still, I know how much harder it has become to get things done compared with when I started practice a decade ago. I have to fight insurance companies more to get the drugs and treatments I think my patients need. I have to refer patients to bigger groups of specialists, and the quality of their service has gone down.
I also have to see more patients to cover my overhead, and there are months when the practice isn't profitable.
Getty ImagesBeing in private practice lets me do things my way, though there is always a cost. I can spend my own time and money on something that fits my idea of what a doctor should be doing. I sometimes listen especially closely to the heart of an anxious patient and do a more thorough exam than absolutely required so that my reassurance may have more impact. Having a healing attitude means having a little fun when you can. Sometimes I answer the practice phone when my secretary is at lunch and just tell the patient to come on over. That really surprises them. Every day, I call several patients at home with their test results or to check up after an office visit.
We are seeing an increase in patients losing jobs, losing medical coverage and just needing someone to care.
One free clinic in the area has seen a jump in requests for assistance from 100 people per month to 100 people every four days.
I spent extra time this month with a young woman with an unplanned pregnancy who drove 40 miles to the office because no other practice in the area would take her public assistance.
Recently, I provided free care to a man with depression. He'd just lost his house, his usual job and his health insurance. At his new job, he makes $8 an hour without benefits. There is no federal bailout in sight for him.
Due to his schedule and the volume of email he receives, Dr. Brewer may not be able to respond to all reader email. He does participate in his forum, where readers are urged to post. His email address is thedoctorsoffice@wsj.com.
Dr. Brewer, 40 years old, grew up in Normal, Ill., where he attended Illinois State University. He received his M.D. from the Southern Illinois University School of Medicine in 1994. After working at a medical center, he established his own practice in 1998. Dr. Brewer lives in Gibson City with his wife Kim, and their four young children.
