About a decade ago, a doctor friend was lamenting the increasingly frustrating conditions of clinical practice. “How did you know to get out of medicine in 1978?” he asked me with a smile.
“I didn’t,” I replied. “I had no idea what was coming. I just felt I’d chosen the wrong vocation.”
I was reminded of this exchange upon receiving my medical school class’ 40th-reunion report and reading some of the entries. In general, my classmates felt fulfilled by family, friends and the considerable achievements of their professional lives. But there was an undercurrent of deep disappointment, almost demoralization, with what medical practice had become.
The complaint was not financial but vocational – an incessant interference with their work, a deep erosion of their autonomy and authority, a transformation from physician to “provider.”
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As one of them wrote, “My colleagues who have already left practice all say they still love patient care, being a doctor. They just couldn’t stand everything else.” By which he meant “a never-ending attack on the profession from government, insurance companies and lawyers ... progressively intrusive and usually unproductive rules and regulations,” topped by an electronic health records (EHR) mandate that produces nothing more than “billing and legal documents” – and degraded medicine.
You may have zero sympathy for doctors, but think about the extraordinary loss to society – and maybe to you, one day – of driving away 40 years of irreplaceable clinical experience.
And for what? The newly elected Barack Obama told the nation in 2009 that “it just won’t save billions of dollars” – $77 billion a year, promised the administration – “and thousands of jobs, it will save lives.” He then threw a cool $27 billion at going paperless by 2015.
It’s 2015 and what have we achieved? The $27 billion is gone, of course. The $77 billion in savings became a joke. Indeed, reported the Department of Health and Human Services inspector general in 2014, “EHR technology can make it easier to commit fraud,” as in Medicare fraud, the copy-and-paste function allowing the instant filling of vast data fields, facilitating billing inflation.
That’s just the beginning of the losses. Consider the myriad small practices – facing ruinous transition costs in equipment, software, training and time – that have closed shop, gone bankrupt or been swallowed by some larger entity.
Then there is the toll on doctors’ time and patient care. One study in the American Journal of Emergency Medicine found that emergency-room doctors spend 43 percent of their time entering electronic records information, 28 percent with patients. Another study found that family-practice physicians spend on average 48 minutes a day just entering clinical data.
Forget the numbers. Think just of your own doctor’s visits, of how much less listening, examining, even eye contact goes on, given the need for scrolling, clicking and box checking.
Why did all this happen? Because liberals in a hurry refuse to trust the self-interested wisdom of individual practitioners, who were already adopting EHR on their own – but gradually, organically, as the technology became ripe and the costs tolerable. Instead, Washington picked a date out of a hat and decreed: digital by 2015.
The results are not pretty. Many, no doubt, feasted nicely on the $27 billion, but the rest is waste: money squandered, patient care degraded, good physicians demoralized.
Like my old classmates who signed up for patient care – which they still love – and now do data entry.
Charles Krauthammer is a columnist with the Washington Post Writers Group.