Leslie was a very competent nursing student from California, while I was an intern in burn ICU. We were at an elderly woman’s bedside, a lady in her 70s with scalding over 10% of her body. Understandably, she was very anxious. I held her hand and looked her in the eyes and said “You will be fine, we will take good care of you.”
Later that evening, Leslie remarked on the reassurance I gave the patient and the impact it had. A few days later I was treated to a cake that the patient baked for me in appreciation of the same.
In stark contrast to that personal connection, this morning I lifted a wristband with a gloved hand to confirm that the patient was KZ, DOB: 09/09/9999. Last 4 of MR number XXXX. I found myself not able to recall his name. However, everyone in the room agreed that KZ was indeed KZ.
As a physician, I always liked to take the time to reassure my patients by offering the physical contact of holding their hand, like I did with the woman when I spoke with her about her problem. This was a practice that helped reduce patient anxiety and helped form a personal doctor-patient bond. Until the Affordable Care Act and mandatory EMR and production pressures changed that.
I now routinely apologize to the patients as I explain the need to caress the mouse instead and ensure compliance with CMS requirements. Patients now get to fill out a satisfaction survey. Repeated surveys indicate patients feeling rushed during doctor’s appointments.
So how do the patients feel about this lack of touch, the inevitable reduction in the amount of time spent with them and the likely feeling of less empathy from the physician? Alas, the Affordable Care Act does not have a survey addressing this important issue.
The mechanization and industrialization of medicine has not clearly demonstrated any benefit to the patient. It has understandably created jobs related to EMR and instant availability of patient information. There is no doubt doctors benefit from having a wealth of patient care-related information at their fingertips. However, there is little to no information about the impact of the distance created between the patient and the doctor by a monitor screen.
Compliance requirements include deadlines to be met, patient questionnaire boxes to be checked in a limited amount of time. This leaves little time for “the human touch!” to the experience of a doctor-patient interaction.
How do we ensure that the patient gets a little time to speak with the doctor, how do we ensure the doctor gets to hold the patient’s hand for a few minutes in between the hours spent holding the mouse?
Small physician practices all over the country are being purchased by larger companies. Production pressures to improve the bottom line for the company has made a doctor’s visit a drive through experience. A handful of concierge practices for the top 1 percent of the population now afford the luxury of a meaningful doctor-patient relationship that isn’t terminated by factors beyond the patient’s control.
The basic intent behind the ACA was to create affordable care while addressing the inefficiencies in the system which add to the expense. While the law makes it mandatory, statistics do not suggest that the efficiency goals are being met or show any signs of being met in the near or distant future, That objective appears to be DOA — Dead On Arrival in medical terms.
Somehow the profits of major health insurance companies, device manufacturers and drug companies have continued to rise at a faster pace since the ACA, just as the consumer pays more each year, gets progressively less time with the physician and likely misses the touch that is now understandably saved almost exclusively for the mouse.
The ACA managed to digitize healthcare, quantify quality measures including patient satisfaction and franchise medical practices and made corporate America happy.
Is the patient happy? Could you find a way to franchise the doctor’s touch? The patients might like that. Perhaps a new survey will confirm that.
The majority of doctors prefer patients over mice, perhaps the patient prefers her doctors over the corporate mice?
