Many of us have been around ‘doing medicine’ for quite some time. The ‘art’ of medicine has perhaps seen more change during this period than any era in the past. Science and knowledge have dashed forward at an unprecedented pace. Modalities of treatment have made remarkable strides. The practice of medicine has mutated into an amalgam of technology and trade. Compassion and ethics as traits, as postulated by Hypocrites are taking a different dimension or are on the verge of extinction. As some of us have bowed out or are planning to quit, let us ruminate over the path of the ‘once noble discipline’ that we have trudged along.
Where did we start and where are we today? There was a time when we bartered goods and services in exchange for health care; then it was cash, or insurance as good as cash. Now it is all credit cards, co-payments, and third-party payers. The financial accounts of p[patients were kept on simple ledger cards manually or with mechanical posting machines. Now it is computerized.
CPT codes were never heard of; now you don’t get paid unless you use those codes. Insurance claims were sent in on the company provided forms; now HICFA 1500 forms are required or claims are submitted electronically. Patients have to get approval from the insurance companies before they get to see a doctor. Managed care and HMOs have become the nomenclature of the ‘new and improved’ insurance companies, the new bosses on the scene.
Doctors used to work with ancillary facilities like laboratories, X-ray, physical therapy and pharmacy, to offer more services to patients. Now, many such groups have been swept under the umbrella of ‘physician management companies’ who have attracted them with the promise of help, efficiency and 118 secure income. The process has cost the doctors their autonomy, the advantages promised having never come their way.
Back then, we used to be ‘doctors’, making independent decisions in the best interest of the patients. Now, the insurance companies call us ‘ providers’ and dictate all the ‘do’s and don’ts in the interest of their stockholders. Morale and satisfaction of the physicians are replaced by frustration and need for survival.
Outside interference used to be limited or nonexistent in medical practice. Now, insurance companies, attorneys, government agencies and a myriad of bureaucracies want a piece of the pie, imposing regulations and restrictions. The regulatory terms HMO, HSG, OIG, OSHA, CLIA have pushed over the medical abbreviations like BID, COPD, ANA, FEV, and GERD.
Physicians used to be alerted by the ‘code blue’ for a cardiac arrest on the hospital floor. Now they can be by a ‘code red’ by a team of FBI storming into their office. Terms of concerns like a ruptured aneurysm, paralytic ileus, tension pneumothorax, and ventricular tachycardia are struggling to survive against the new lexemes like corporate compliance alert, fraud and abuse citations, mandatory and permissive exclusions and cumulative sanctions.
When a patient called a doctor’s office, a receptionist talked and assisted them; now they are welcomed by mechanical voices, mazes of options and uncertain choices. Secretaries took dictation by shorthand, typed them up and recorded them on charts; now it is all done by voice recognition devices and computer software.
A medical record used to be what the doctor felt necessary for his style of practice. Now we are told to check the ‘bullets’, post the ‘codes’ and substantiate your services before a statement is billed, lest you end up getting fined or put behind bars. And the patient’s’ medical records used to be private and confidential; saved by the doctor who took care of them. Now, anyone who pays the claim can access their charts. Privacy now can be purchased for a price. Progress, like beauty, is in the eye of the beholder.
Dr. Venugopal Menon's 'Thoughts of a Lifetime' 