Problems with Medicine by Mandate

With the passage of the Affordable Care Act, most physicians knew big changes were coming. But most did not realize just how much things would change. Little did they realize that they would have more duties and responsibilities dumped upon them while seeing a decrease in revenue.

We are also witnessing simple operational cost-savings tactics being used by all payers today. Many demand documentation to support a diagnosis - which is reasonable if they are writing the check. However, they then want to outline to the physician what the treatment plan will be. Payers believe that best practices and protocols will always apply to the broader patient population and thereby reduce their costs.

Today, I feel that physicians are like the bank tellers or checkout attendants of yesteryear. If you notice, many stores have a self-checkout lane and banks use ATMs. Why? It's to shift the cost of labor onto the consumer; they want you to do their work. Physicians are now in the same predicament. For hospitals to satisfy the computerized physician order entry (CPOE) mandates, patient orders must be entered by a physician. We've become the hospital's ward clerk, for free, while we reap little of the benefits of government incentive programs. Nothing irritates me more after dealing with a patient emergency or code [blue] than to hear someone ask, "Are you going to put those orders in the computer, doctor?"

The IT mandates under the reform law have made life as a physician more frustrating. It typically takes longer to input the data into an EHR rather than simply write it down. There is now the perception that we spend more time looking at a computer screen or tablet than we do talking with the patients. My family members have complained about their doctors doing this. I, too, have found myself doing the same thing and it really irritates me.

One of the reasons for the IT mandates is so data can be harvested and examined for quality purposes. This data is used to label physicians as either "good" or "bad" based upon their patient population outcomes. Here arises my largest issue with the whole trajectory of the healthcare system. When I became a physician, I accepted some responsibility. I became responsible to my patients; to provide the best care possible. With thoughtful actions and their best interests in mind, I make the best possible clinical decisions and recommendations. But that's where my responsibility ends. I am not responsible for my patients. I am not responsible for their actions, what they eat, if they exercise, if they smoke, or if they follow instructions and take their medication appropriately. I am responsible to them, not for them. However, it seems that everyone else is attempting to make physicians responsible for their patients' actions despite the fundamental issue of free will of the patient.

Physicians are still the driving force in our healthcare system. We make all the decisions regarding patient care. Drugs are not dispensed without our orders. Procedures are not completed without our skill sets. And now, orders are not entered in a computer without us. CPOE isn't computerized personnel order entry, it is computerized physician order entry.

The industry still depends upon our leadership and knowledge. Now is the time for all physicians to stand up and speak out. The evidence is clear, these mandates are working to drive down physician morale and decrease the quality of care we provide to our patients. Remember, we are responsible to them for excellent care. We must fight to protect our ability to provide that care. We need to be fighting harder to transform the healthcare system into something that we would be happy to use. Because in the future, we eventually will.

David J. Norris, MD, MBA, CPE, is an anesthesiologist at Wichita Anesthesiology Chartered in Wichita, Kan., the owner of the Center for Professional Business Development, and a member of the Physicians Practice Physician Advisory Board. How are mandates dictating your work as a physician? Tell us at editor@physicianspractice.com. Unless you say otherwise, we'll assume that we're free to publish your comments in print and online.

This article originally appeared in the June 2014 issue of Physicians Practice.