This is a guest article by Silvio Aladjem MD
After 40 years of practice, my time had come to retire. I must confess that I miss the daily patient contact, the first cry of a new baby that I was bringing into the world and the feeling that I was doing some good. I enjoyed and loved my practice.
But life must go on and I was no exception. I keep up with medical news, I continue to get my CME (continuing medical education) hours and, on a regular basis, I keep on taking proficiency examinations. Not practicing is no excuse, to me, to forget that I am a doctor. Besides it keeps me busy with an activity I loved for all my life.
I also keep in touch with my peers, whether as a patient myself or by being with other physicians on multiple social occasions. What surprises me is that none of my colleagues are smiling. One can see their preoccupations by the way they walk or by the way they talk. They hardly ever laugh at a funny story. It is vexing. Almost painful.
In our conversations the common comment is: “You are lucky that you retired” or something similar. I know that the practice of medicine has had many fundamental changes compared to when I started practicing, but what I am hearing is more profound.
We all know that the way physicians practice today has changed. It’s not that. What concerns everybody is that today’s medicine has become a business.
Probably a majority of physicians today are hospital employees. Physicians lost their independence and as such lost control of how they practice. Today administrators dictate how medicine should be practiced, not always for the benefit of the patient but for the benefit of the bottom line. One colleague told me that he can’t order supplies anymore as his clinic needs. The hospital administration decides now what supplies are needed and when! Rarely any new drugs are available. You have to make the best with the generics available in the hospital pharmacy.
I remember going to see my doctor, who is now part of a hospital based multispecialty practice and really being shocked by a notice posted in his office: “Your doctor can only address one complaint during your office visit.”
“What’s going on” I asked him, pointing to the notice.
“You don’t want to know”, he answered. “We can only spend 15 minutes with each patient. If it weren’t true it would make a good joke”.
I was personally annoyed with the fact that my doctor was busy on the computer entering the answers to his questions and, proportionately, spent more time looking at the screen than at me, the patient.
When I left I was given a printout with a summary of my visit. Facetiously, I asked if the time taken to print was included in the 15 minutes clause. I just got a look!
Next day I received an email from the hospital with a questionnaire for me to evaluate my satisfaction with the office visit. I learned that such satisfaction questionnaires are mandated by the Government. I looked it up and I was wondering if it referred to my medical office visit or to my shopping at the groceries store. Such questionnaires are self-serving, irrelevant for medical practice and mostly inappropriate. Furthermore the questions are the same whether I was a heart patient, went to the doctor for a cold, had surgery or cancer!
I learned that the questionnaires sent to hospitalized patients after discharge, have been standardized for the purpose of comparing hospitals nationwide. I have not seen the in-patient questionnaire, but I am wondering how does one compare a busy trauma hospital, like Cook County in Chicago, for example, with the local community hospital with only 60 beds or less and no trauma department? I am told that good surveys will bring more money to the hospital from the government. Oh my!
I am also amazed that patients don’t care about these changes. Don’t care about who is seeing them, don’t care that they have no continuity of care, that they are treated as a nuisances which takes away from the precious time of filling the forms that the electronic record system spits out. They don’t seem to care anymore that the humanity of healing has been replaced by a disease code number to be transmitted to the government so that a reimbursement is issued.
Pretty soon you will be able to take care of yourself at the same time that you buy your groceries. Walmart will be offering walk-in clinics for primary care staffed by a nurse practitioner. They already have such clinics opened in Texas and North Carolina.
I look back and I am beginning to understand why my colleagues make a point in telling me that I am lucky I retired. What’s worse, I am beginning to believe they are right.
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website, www.drsilvio.com