025 Discussing Healthcare: A Physician Rant

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In the News

NBC News reported about an outbreak of gastroenteritis (vomiting and diarrhea) at a conference about food safety.  It is ironic that a food related illness infected a large number of people at a food safety conference.  However, food related illnesses are common and have affected most of us at least once in our lives.

Physician Rant

Mimi Zipser, MD

Mimi Zipser, MD

Mimi Zipser, MD is an Emergency Physician.  She has seen a transformation in healthcare that has her concerned about her profession.  She is frustrated with the business mentality that is taking over medicine.  One of her main concerns (along with many other physicians) is that patients are now being valued as customers and not patients.  Patient satisfaction surveys are now more important than appropriate patient care.  Patients expect certain diagnostics and treatments based on information from the internet and other sources.  Some patients are not willing to accept a different viewpoint and become upset with physicians who do not comply with the patient requests.

Dr. Zipser’s concerns are valid and supported by many physicians in practice today.  She recently wrote a rant about her frustrations with the healthcare industry.  Here is Dr. Zipser’s rant:

 

I apologize for the ensuing rant but these are thoughts weighing heavy on my mind tonight…I am saddened by the fact that my profession as a physician has seem to become a field where instead of respect for the 11 years I spent in higher education obtaining my degree, I am overshadowed by celebrities and well meaning but poorly educated parents telling me I have no idea about the true ramifications about vaccinations. I am told time and time again that a patient has diagnosed themselves via Google and doesn’t understand why I am not treating them for x,y, and z. I am told frequently that if I don’t order a certain test or imaging, that I will be sued if I miss something. I am berated by patients who tell me I am causing them harm by not refilling their narcotics for chronic pain or giving them narcotics for even a simple bladder infection or an antibiotic for their “cold”. I am overshadowed by hospital administrators judging my quality and worth as a physician based not on how accurately or well I care for a patient medically but on how high my “CUSTOMER SATISFACTION” scores are. And in that same breath they are telling me customer service is a key factor, they strip away more and more of my time away from my actual patients by placing me in front of an electronic medical record system so I can place all my own orders, spend more time charting my interaction with the patient then I actually have physical time with the patient and then spend more time answering emails about how a “Customer” was dissatisfied with their ER visit.

 I AM A PHYSICIAN. I studied hard so I could help care for others in their time of distress and need. So I can tell someone how best to treat their condition based on evidence supported medicine. So I could possibly save a life of someone I may or may not know. So I could be an empathetic bearer of bad news to the family of those that I could not save. I AM NOT a secretary, a waitress or a salesperson helping you get the shirt in the size you want. There is not a single thing wrong with any of those professions, but it is not MY profession. NOT what I went to school for. I am not in the customer service industry. My job is not to satisfy people. The customer is NOT always right in my profession because PATIENTS ARE NOT CUSTOMERS. Patients are people with illnesses and pain or injuries who seek my help because I may be able to provide them some respite from their ailments. Patients once upon a time actually listened and physicians used to garner some respect…or at least that is what my job used to be…I feel that administration and misconceptions about how the medical field should be run has tainted what used to be a truly altruistic field. I love what I do. I love my job. But it is getting harder and harder to maintain the love with the constraints and disrespect administrative and social roles have placed on my profession…again, sorry for the tirade. I don’t usually post things like this but felt like I needed to get these thoughts off my chest.

 

Dr. Zipser’s frustration is evident.  Physicians value the relationships we have with our patients.  We enjoy the challenge of diagnosing and treating patients.  However, our jobs are difficult.  Now, we are given added non-clinical tasks of charting in inefficient electronic medical records while ensuring every patient is “satisfied” with their care.  It seems almost impossible at times to balance all of the responsibilities put on a physician by the healthcare system.

Dr. Zipser is not the only physician frustrated with the current trends in medicine.  Check out these articles as well:

Are Physicians Just Complaining?

Physicians, like most human beings, often resist change.  So, are physicians just complaining about change or do they have valid concerns?  I would say a little of both.  Certainly there are valid concerns about the direction we are going in healthcare.  Take patient satisfaction surveys, most physicians loathe the thought that patients are given a survey to rate the physician interaction.  Patients often are not satisfied with the physician for many reasons.  Patients often want antibiotics and pain medication inappropriately.  They want CT scans and labs that are not warranted.  In the emergency department they want to be admitted to the hospital when there is no clinical reason.    Even after spending time and energy explaining why these things are not needed some patients expect them anyway.  They leave the physician’s office, the emergency department or the hospital angry, upset and frustrated and give the physician a less than flattering rating on a survey.  In 2012, JAMA published an article called “The Cost of Satisfaction.”  This was an original research paper that studied the affects of patient satisfaction in relation to patient outcomes.  In short, the study showed that satisfied patients used the emergency department less, but had higher healthcare costs, payed more for medication and had a 26% increase in mortality.  That’s right a 26% increase in mortality.

Now, what do you think about patient satisfaction?  Yes, we as physicians should want our patients to be happy.  But, at what cost?  We are bending over backwards to make sure patients are “satisfied.”  Physician pay is increasingly partially based on patient satisfaction scores.  It just seems that the healthcare system is not worried about the things that really matter most….patient outcomes.  Would you rather be happy or healthy?

On the other hand, physicians need to help change medicine for the better.  The healthcare system spends too much money.  Physicians are greatly responsible for the cost of healthcare.  Although physicians do not control the cost of medical technology or medication, we certainly have some control over what an individual patient consumes within the healthcare system.  There is little focus on preventative care.  In my mind, the best way to control costs is to avoid the diseases that cost the most.  Many of the diseases we face in the United States are preventable and a lifetime of better choices can lead to decreased healthcare costs.  We physicians should take a central role in the prevention of chronic diseases.

Healthcare is changing in this country.  The biggest stimulus for change is the Affordable Care Act.  This law has some aspects that will improve the healthcare system.  But, there are also areas of concern with this law that need to be addressed.  Whether you support or disagree with this law, the biggest question we need to answer is “should the government control healthcare?”

I don’t know the answer, but I do know that in general physicians are not happy with the trends in medicine.  We feel devalued.  We are losing our autonomy to care for patients in a manner that we see best fits each patient.  We are pressured to keep patients “satisfied” instead of healthy.  We are asked to see more patients, never make mistakes, chart using software systems that are inefficient and labor intensive, keep patients happy at all times, and smile while doing it all.

The word is out…life as a physician is not as satisfying as it was in past years.  Physicians are retiring early.  They are leaving their current practice to start cash pay businesses in hopes of practicing medicine in a more personal and simpler manner.  They are seeking business opportunities outside of medicine.  Why?  Because healthcare is headed down a road that physicians never wanted to travel.

 

About the Author

I am Joshua Lewis, MD, the creator of Discussing Healthcare, LLC and a board certified Emergency Physician who currently practices in the Phoenix, Arizona area. I hope you will gain meaningful insight into our healthcare system through the information provided by Discussing Healthcare. Thank you for your interest and I encourage you to contribute by calling, emailing, or leaving comments on the website.

6 Enlightened Replies

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  1. Here, here, to an articulate and well written tirade, Dr. Mimi Zipser.

    • J Lewis, MD says:

      Alice, I agree. We physicians should continue to sound the alarm when we see trends that are negatively affecting patient care.

  2. Diana Breed says:

    Thank you for voicing our concerns. Where are the expensive research results that report “satisfied” patients (customers) live longer or with a better quality of life?

    • J Lewis, MD says:

      Good question. Unfortunately, good patient care is not at the center of patient satisfaction surveys. I’m not sure that the powers that encourage or force these surveys really care about the results of patient satisfaction. Maybe I am wrong. Perhaps if more data is gathered to support bad patient outcomes with high satisfaction then these surveys will fall out of favor. Until then we will continue to focus on the wrong things.

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