I am blessed by the fact that I really do love what I do as a physician.  I love seeing folks every day and seeking to sort through the problems they’re struggling with, figure out what malady is underlying their symptoms, effectively treat it, make plans with them for preventing other big problems down the road, and along the way, get to know them personally.

At the same time, I can’t help but notice that many of my colleagues feel hassled and unfulfilled and are retiring early.  Likewise, patients feel that medical care is more and more frustrating with big bills, short visits, and impersonal, distracted interactions with physicians.  With insurance they pay more and more to get less and less coverage while losing more and more control over how and what they receive in medical care.

For my part, I feel those same pressures on both me and my patients.  When I began practicing medicine, I could still readily focus on my patient, take the time I felt was needed with them, decide what further tests were necessary to arrive at a diagnosis for them, choose which prescription or course of treatment would be most effective, document a note in a minute or two, and charge a reasonable fee for the service.

Now my patients and I feel competing, resisting, and frankly annoying forces at each step.  It’s harder to focus attention on my patients because insurance companies and government agencies require massive, multi-page notes full of minutia that helps neither me nor my patient and takes my eyes off the patient and on to a computer screen.  To try to solve this I finally hired a full time medical scribe to help keep the notes so that I could focus back on my patients.

Next when, after hearing from and examining my patient, I decide which tests are needed to help diagnose their problem, I often need to battle with the insurance company to convince someone who has never seen my patient that the test is necessary.  This involves more time from me and my staff and often delays diagnosis for my patients.  Next comes the course of treatment.  It is no longer just which treatments or prescriptions would be best, but the all-important question of what insurance will allow and cover.

I could go on but you get the picture, and as patients you’ve experienced it.  The personal doctor – patient interaction is being taken over by distant, impersonal entities steadily engulfing every step of medical care.  Time, attention, and cost are increasingly going toward satisfying these entities instead of taking care of individual patients.

So what’s the core of the problem, and is there a reasonable fix?  The answers to those questions are larger than a column this size can fully tackle.   But maybe with this and another in two weeks we can make a helpful start.

We can count on the fact that the one paying the bills for medical care will eventually control the care.  When we moved to a system of insuring medical care at every level we started down the road that has brought us to this place where patients and their physicians are no longer in control of care.

Normally insurance involves many people pooling their resources to be able to afford to pay for an unlikely but expensive event.  So catastrophic medical insurance makes sense. But we don’t use our homeowners insurance to cover repainting a room, or our car insurance to cover an oil change.  Likewise, we shouldn’t use medical insurance to cover every physical or strep throat.  These are routine, expected services.  When we began to use insurance to cover all of them, the total cost began to go up and the control of the visit began to be taken away from the patient and their physician and given to the insurance company or government agency.

Each time a large entity such as an insurance company or the government promises or implies that they will take care of us, we need to remember that sooner or later there will be a very substantial cost, sometimes in dollars, and sometimes in loss of control over every level of the medical care we receive.  Experience has borne this out.

Ok, so that is a very brief picture of some of the problems facing us in getting affordable, effective, personal medical care.  It is not at all intended to be a rant a whine or an idle complaint, just an objective look at where we’re at in medical care.  It is an attempt to diagnose the cause of our problem.  And I believe there may be a cure for the cancer that is eating up medical care, or at least some steps that can put it into remission.  But, as you so often may hear from your physician, we’re out of time and that will have to wait for two weeks from now.