December 23rd, 2019

After discussing the patient doctor care relationship topic with a few people, it was recommended that it be shared here. Here it is:

Open letter to parents and patients:

Over the past few years, I have noted with dismay the statements people make in the doctor's office or in other locations related to doctors and care providers. What I am about to say is not about my hurt feelings or just my general complaining. Rather, I am hoping that this passage will give everyone a better understanding of patient care, work load and time constraints that exist today.

Right or wrong, my hope is that this passage will provide insight into the why things happen as they do at times, frustrating many parents, patients and providers alike.

Over the years, I noted that online reviews for medical providers were generally if not always negative. Once, a gentleman sitting next to me, was bragging about his divorce and the fact that when all of the dust settled, he had 5 or so bills left to pay. All of them were to his care providers. He stated emphatically that they did not need his money anyway and he wasn't going to pay them. When a patient is late for an appointment, I have received complaints that we make them wait so why is the reverse not fair?

The common theme here is a pervasive belief that we, the care providers, are neither good at what we do, worthy of some people's time and money, or worse, we take your time for granted. In my mind, none of these are truths. We value everyone's time, money and effort. The reality is more the function of a dysfunctional medical system that has put profit over patient care, computer analytics over time spent with a patient and finally diagnosis and acute treatment over living free of disease through prevention and generally healthy.

I am generally not a cynic when it comes to life or medicine. However, the pervasive changes to medical care delivery over the last decade and a half are pro convenience and speed over quality and happiness. Studies find that many consumers are very happy with these changes as they fit our convenience culture regardless of outcome quality. However, these changes have been a juggernaut in the wrong direction because the above dysfunctional changes are now officially here and the results are in. The outcome is not in anyone's best interest from a quality perspective.

Your average provider is tasked by the federal government and local hospital system with navigating a cumbersome electronic medical record system that does little to improve patient care and certainly not an improvement over the narrative that existed in the old "paper" chart. The other day, I spoke with a pediatrician in another part of the state who routinely stays up until 10-11 at night finishing charts in the system in order to be "compliant". This is a sure recipe for burnout and frustration. If there was a huge value add from this system, we could stomach the time waste. Alas, neither exists. We should be prioritizing time spent learning and treating the patient over cumbersome wasteful charting.

Your average provider spends hours a day reading to be up to date with the crazy volume of information percolating up from the science literature about the newest disease or treatment. This is on top of a full day of work. This task is much harder to achieve than every past successive decade. The information volume is at times overwhelming forcing many providers to silo their knowledge into specialties to be able to control the learning stress.

Your average provider tries to spend as much time as necessary with each patient to address all of the concerns raised. Now here is where the biggest friction point occurs. If for example, a patient has an 8 am appointment and they arrive at 8:00 am or 8:05 am (technically not late according most practices), the whole schedule just got delayed by 5 to 10 minutes while the check in and vital signs are gathered. Let's say the patient is scheduled for a rash visit which is generally 8-15 minutes long and the visit turns out to be a bit complicated. You have to spend 25 minutes to adequately handle the case and treat the patient in a complete and effective manner. This is and should be the only way to practice correct and quality medicine. Unfortunately, now the next patient's appointment which was scheduled for 8:15 am is already 15-20 minutes behind schedule. This scenario is very common. Thus, I ask for two indulgences for all of my colleagues: 1) please show up 10 to 15 minutes before your appointment and know that we are trying very hard to be on time. 2) Know that if a child has a severe issue, the entire apple cart may get flipped over for everyone in order for us to be present moment and give 100% to this family.

Your average provider really cares about your child and you. They want to spend the time with you that you need to be educated about whatever is happening at the time. The big problem here is the disconnect between time and money. Time is neither compensated nor respected by insurers nor hospital systems. A gastroenterologist friend of mine recently informed me that his hospital system overlords are tasking him with seeing new patients with significant disease like Crohn's and cancer in 15 minutes or less or take a pay cut or worse be fired. Frankly, this is not good medicine. The best that this person can do is diagnose and prescribe. Forget about teaching disease etiology, prevention and lifestyle changes for the future. I think that the pendulum will start to swing back in the coming years as time and teaching are recognized as the most important medical tools for healing. I am waiting patiently.

Your average provider went into medicine to heal. It is a long and arduous journey. Money is not the driving force for most as there are many easier ways to make money.

I will end with this statement. Thank you for trusting us with your loved ones care. We will continue to strive to be the best at what we do for you and all of your family. We will try and navigate the crazy medical system as best as we can.

Thank you for your patience,

Dr. M