Behind that computer in your doctor’s office, there is a war going on. As a patient, it affects your care. Your doctor is pushing back on the forces eroding your quality of care, but they are being torn apart by legislation, bureaucracy, and big business. Unlike, 30 years ago when doctors controlled patient care, your doctor is being outflanked by powerful people that did not go to medical school or swear an oath to protect.
Your doctor gave up a decade of their life to learn how to heal you, and they are trying desperately to do that. There is a fight to control every aspect of your interaction with your doctor including the tests they can order, the amount of time you have together and the therapies they can prescribe. However, the odds are against them. Doctors are overloaded by paperwork and busy schedules, leading to a cycle of decreasing physician power. Doctors are catastrophically busy caring for patients in an increasingly complex health care system.
However, each minute they spend with patients is a minute they cannot spend lobbying against measures that increase profits and decrease health care quality and physician autonomy. This power dynamic often comes across to patients as callous disinterested physicians. I know this because I have experienced the best and worst of medicine because I am a chronically ill patient. I am also a physician.
I know how frustrating, scary and futile doctors visits can be. I also know what it is like to have medical bills stacking up on your counter while still not being well enough to return to work. On the other hand, as a physician, I have spent hours on the phone fighting for services and treatments, only to feel the frustration of these efforts failing to lead to better outcomes for the patient. The patient and the doctor want the same thing. It is forces outside the room that destroy their relationship and lead to disillusionment for all.
In the past, most doctors were self-employed and could choose to give time for free, but the current state of medicine has forced doctors to be employed and their time belongs to the hospital administrators. Every minute of that visit with your doctor is subject to scrutiny by administrators. For example, if your doctor talks with you for 30 minutes about the recent loss of your family member, they will be reprimanded by administrators if they don’t produce a billable diagnosis to justify talking for 30 minutes. The administrator places constant pressure on the physician to utilize every second of the day to make financial gains.
There are additional hurdles for physicians with insurance companies dictating patient care. Doctors are often pushed towards providing the cheapest but not the best care for their patients. One of many weapons used against the physician and the patient is the prior-authorization. This is time-consuming and not reimbursed by insurance companies. Physicians easily can spend 15 minutes in the room with a patient because that is all that the insurance company will pay for but 45 minutes on the phone and fax machine with the insurance company to get the best medication approved for the patient.
While the administrators and insurance companies gain more power, through time and legislative initiatives. Doctors are fighting desperately to give their patients the best care. Doctors devote their time to patients (as they swore an oath to do) yet they are punished for doing so, by special interests (who have the luxury of resources to advocate their own interest).
I want to finish by thanking the doctors who saved my life by sacrificing years of their own lives to learn the diagnostic and treatment skills needed to recognize and effectively treat a zebra-like me. It took decades and tens of thousands of hours of education to be able to recognize the subtle differences between my diagnoses and more common conditions. I would be bedridden, if not dead, without you. For all the precious moments and your own health which you sacrificed, the meals you skipped, and the sleep you lost to save patients like me, I thank you from the bottom of my heart.
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