The status quo in health care is changing.  That is painfully obvious to both patient (ie everyone) and healthcare providers (formerly known as “doctor”).  It has to do with both economics and  the philosophy of health care in this country. 

Everyone understands that the cost of health care has been rising for many years now.  Ironically that rate of increase may have stabilized somewhat.  But the causes are often misunderstood. 

Healthcare technology is always changing, evolving and hopefully improving.  Innovation costs money.  Is that a shocking revelation to anyone?  New drugs are expensive to bring to market.  Our aging population is surviving with chronic diseases longer than ever.  There are millions of poor citizens who cannot contribute to these costs and yet are never refused the health care that they need. 

Enter the beaurocrats/ politicians/ PhDs in social planning/ economists etc. etc.  Each has their own solution for fixing the problem. 

What may ultimately be the greatest casualty in this health care debate  is the time-honored patient-doctor relationship.  Some cynics will claim this was always an illusion.  Some will claim that physicians were always interested in generating income on the backs of those who relied on them. 

Those who direct public policy have come down hard on physicians as the source of much of the problem.  They insist that we don’t practice according to established guidelines, that we order tests, call consultants and overdo everything out of greed.  They imply that defensive medicine is an excuse for lining our pockets with income generating tests and procedures.  They dismiss the impact that malpractice claims have on physician attitudes towards their patients or the overutilization of defensive practices. They refuse to consider binding arbitration approaches to medical malpractice disputes and deny the role of lawyer PACs and their influence on the process. They insist that electronic medical records leads to better health care for all.  They tout the benefits of electronic medical records while every physician and every patient understands the absurdity of such a claim.  They insist that patients do not need options in the medications we prescribe but that one generic per diagnosis will be sufficient.  They believe physicians need oversight when our clinical judgment impels us to order a test or call in a consultant when this does not conform to some their own templates of care.  They believe that salaried physicians will see as many patients and keep later hours than those who receive compensation for what they actually do.

They deny the power of the sacred place which is the relationship between patient and doctor behind the examination room door.  They insist that social media contacts and skype approaches will easily and cheaply substitute for such face to face encounters.  

The system awaits young physicians who are seeking full time 9 to 5 types of pracitices.  They have no interest in getting called at night or on weekends for their patient’s problems.  Those who get sick after “banker’s hours” will find themselves in ERs or medimerge facilities, essentially on their own.

In short they are forcefully molding the transformation of health care as we have known it.   To point out that this will  be a difficult transiton is an understatement.  

I will very likely leave practice a better and more knowledgeable physician than I was 5 years before, one year, before, even one day before I retire.  My experience and sense of awareness grows each day I stay around.

In other words I will be leaving before I should or need to.  Yet when I do (I am turning 65 next month) it will be out of a deep sadness and frustration about the state of affairs involving our health care system.

Sorry to inject such negativity but, let us pray for some infusion of sanity into a system bound for inferiority.

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