It's become a sisyphean nightmare.
Endless reguirements for documentation to get paid, defending one's actions so the patient will get paid, justifying one's actions so the hospital will get paid, while covering your ass so you won't get sued. All while trying to take care of patients.
We are left to wonder, where has healthcare gone?
The answer is simple: it's gone the way of the bureaucrats.
It's gone the way of quality assurance.
It's gone the way of intolerance to error.
It's gone the way of patient satisfaction surveys.
It's gone the way of sterility, MRSA screens, hand sanitizers and no white coats.
It's gone the way of efficiency and cost-effectiveness: to electronic medical records that use voluminous electronic plagiarism to get the maximum Medicare allotment of money for the least possible work while doing nothing to improve the actual management of a patient. (Being a slave to the inpatient world, I don't know how I'd survive without this now).
And now, it's going the way of guidelines on top of guidelines. You see it wasn't enough to have guidelines for management of acute coronary syndrome, or non-Q wave myocardial infarction, or management of heart failure. Now we will soon have guidelines directing us to which coronary stent we should use. Mandated by the very FDA who is paid by the device companies to review their products. The same FDA that will charge $43,190 to review a single direct-to-consumer ad, plus a one-time operating reserve fee of $82,780, because they have to pay 27 additional staff members to assist with those reviews.
Bureaucracy on top of bureaucracy.
All done to feed more bureaucracy, not to really effect healthcare delivery.
It's no wonder the healthcare industry is the second most regulated industry behind the nuclear power industry.
I searched for AHA (American Heart Association) Scientific Statements and found 16,442 such statements on everything from heart attacks in the elderly, to dietary recommendations, heart attack care, arrhythmias, evaluations of athletes, and much more. It is an impressive array of statements and recommendations. But these "statements" and guidelines have become so commonplace, that their usefulness has waned.
Except to lawyers who say, "See, I told you so. Now you have to pay!"
Or regulators who say, "You idiot! I told you not to do that!"
And insurance companies bent on denials: "See, we don't pay for that under those circumstances."
Fortunately, I know plenty of doctors who listen to and speak with their patients. They've stopped seeing people in 7 minutes. They see them in 15-, or 30-, or 60-minute appointments. They don't miss things because they take their time, are thorough and follow-up with the referring physician or family. They work patiently, yet efficiently and never say no to a consult. Even on the same day. And their practices are thriving.
No voice recording on the phone. Real people who respond to your needs.
They're entrepreneurial. Risk takers. Organized.
And they don't take insurance. Ever. But they'll help you get reimbursed, if you so choose.
This is the wave of the future, and slowly, gradually, things will change.
For the better.
Now I just have to figure out what us specialists will have to do to survive...