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President’s Letter
Sooner or Later
By Stephen J. Ezzo, MD
Itried. I really did. I promised myself I would not go down this Jumping through hoops/asking questions to fulfill some government/
pathway. I promised my wife, my mother, and the memory of
Walker Percy, the first of many physician writers who spoke to insurance/ACO idea of sound medicine when outcomes have not been
me. I tried to be a team player, a good soldier. I shrugged off
shown to improve serves neither the patient nor the doctor. For many
of these matters one does not have the time or resources to properly
losing bits of my individuality, with the rationalization that others follow-up and change behavior.
might have some good ideas and my quality and efficiency of Do not recycle failed health care policies from years past, slap a new
patient care might improve. Or that railing against such things was a acronym on them, and think they will somehow magically work now or
Sisyphean task. But somewhere along the way the scales tipped, and that we won’t notice.
I became mired more and more frequently in a Kafkaesque world. Please explain the constant re-defining of coding. Is it time, or
When you want to know The rules and regulations complexity, or prescriptions written, or experience? If experience, does
how the battle is faring,
and sameness that are that mean I can charge more than my new partner for the same illness
being foisted upon me are
sapping the joys of practice, encounter? If complexity, can I copy and paste a 24-point ROS that
you ask the troops in the I did not ask in order to upcode? I have learned that when rules are
field and not the brass
transforming a profession frequently changed it is either because no one knows what is going on,
into a job.
or they know all too well what is going on.
I had no intention of
back at headquarters. After years of practicing and caring for a consistent group of
complaining in these illnesses, do not suddenly inform me I am no longer qualified to
letters. I strove to write with
diagnose and treat certain things. I have my training and Academy to
eloquence and elegance, tell me that, along with the Hippocratic Oath.
to have you laugh at my cleverness and to pause and consider my Do not pre-authorize me to death. Do you think I have failed to
observations. After all, if you wanted to hear me complain all you consider the risks/benefits to the patient, or that I am hanging out here
needed to do was talk to me in person (or ride in a car I was driving). It in the sticks ordering things How does building an
willy-nilly? I understand express care, urgent
would come soon enough. you want to save dollars and care, free-standing
control healthcare costs. News emergency room and
But I am now in my fourth decade of medical practice. There are flash – so do I. If you insist medical office complex
on pre-auths, grant me a few on every corner keep
some things I know. I hope — and think — I am aware of the things I favors: make them equal across down the cost of health
all fields and settings, and when care? Who is going to
do not know. I am fairly certain I understand what makes doctors tick, I must speak to someone in
your company, make sure they pay for all this?
and how they can best function in their work environment to provide answer the phone the same
day I call, have a rudimentary
the most appropriate, compassionate care for their patients. None of this knowledge of medicine and are
not just reading from protocols.
is unique to me — this knowledge reaches across specialties, settings
The art of examining,
and age groups.
You may recall a recent article of mine on restraint, a quality I strive to
incorporate more into my life with age, as I have learned the daily crises
we face are rarely as bad as we anticipate. But when one’s tolerance is
repeatedly bludgeoned, restraint by necessity is pushed aside.
The usual suspects are to be found here, mainly those entities that see
health care through a different lens than we do. While I do not doubt
their sincerity (OK, at times I do), when you want to know how the diagnosing, and treating the
battle is faring you ask the troops in the field and not the brass back at vast majority of problems is still done best in the exam room with both
headquarters. physician and patient present. To suggest I can actually fully examine
Will any of this make a difference? I doubt it. This train left the someone —look at their throat and ears, listen to their heart and lungs,
station a long time ago and shows no signs of either slowing or altering palpate their abdomen — via an email or video visit is to offer a false hope.
its course. Vox clamantis in deserto?* Perhaps. But one never knows the The way we perform our calling is highly individualized and in large
impact of a voice until it is raised. Besides, the cacti do not judge and part based on our own internal clocks. The pace we set for ourselves is
the sunrises are breathtaking. time-tested and best suited to us alone. You cannot expect us to be on
If you insist that I engage an EHR under the penalty of finance, the same schedule and to see patients in the same interval regardless of
please give me one that thinks like a physician (there are books written the complaint. What is next, assigning us numbers instead of names?
on this subject), is user friendly, and does not crash on a daily basis. My How can you “personalize” medical care when you increasingly take
staff and I grow weary of playing Russian roulette to see which exam away the physician’s ability to personalize his/her work style? Tell me,
room is working today. where is the value in that?
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