When you become a doctor, one of the fundamental tasks required is to be a great listener. We listen to the patient’s heart beat, their breathing, their intestinal sounds, and most importantly, their story. How a symptom starts is usually a clue as to why they have it and therefore how to treat it.
Recently, we have stopped listening. The current sequence of necessary steps that delivers a patient from symptom to cure is impractical, if not all together wrong. We are so focused on the process we ignore the purpose.
For example, say a patient twists a knee playing basketball or discovers a breast lump in the shower. For the patient, their priority is to get it “checked out” as quickly as possible. Nothing is more debilitating than pain or anxiety. However, the priority for the insurer, or more importantly the employer who pays for it, is to immediately limit cost by limiting access or restricting coverage. Doctors work within the system, and the rules that govern it, because there is no alternative, and we play along. The patient is put on hold, sent to multiple stops for approval or testing, and then finally allowed to arrive at their destination. All these costs are not accounted for because they are absorbed by the patient.
The current system has devolved into a series of billable encounters that do little to actually resolve the clinical problem. You can argue some of these steps can even make it worse as insurers often follow outdated or inaccurate guidelines for care. The doctor also becomes complicit as we shoehorn a patient’s condition into allowable, and therefore billable, choices. But most physicians will agree each patient’s story is unique and how they respond to treatment may not always be predictable. That’s the art of medicine. However, we are often forced into algorithms that no longer benefit the patient, but as long as they are “not less inferior”, they are acceptable.
Physicians are very unhappy about the current practice of medicine, and that’s not to say we aren’t energized by our patients or enjoy teaching young doctors. It’s just the other stuff that used to be only a small annoyance has grown like a tumor and has all but eliminated the patient’s immediate need as priority. The encounter becomes impersonal, and therefore everyone expects less from it. No accountability means no real communication is necessary, so we just stop listening.
It’s time we give our patients a voice. UBERDOC is all about making a simple and transparent connection between the physician and patient first, and then worrying about all the other stuff later. Maybe if we start to listen again, we can change the system.
Paula Muto MD