Wednesday, December 05, 2007

The good doctor worries about his patient

When I began private practice of pulmonary disease and internal medicine in the late 1970s I had spent the previous one year doing research at a medical school and before that two years in the army. The thing that impressed most in my first three weeks of work in a moderately large group of internists was how much my partners seem to really care about their patient and how they actually worried about them.

A recent essay by Dr. Philip R. Alper entitled "Being a good doctor" reminded me of those thoughts.He writes a regular column in the Internal Medicine World Report and I have quoted him before.

In this essay he is reminded of a comment made to him many years earlier by a colleague of his who said "You know good doctors worry about their patients".

Alpert continues:

Doctors who worry about their patients keep up-to-date, listen to their patients and think about not only what they say but also what they haven't said.They second guess their own impressions because they are aware of the potential for error. More than adherence to clinical guidelines or being paid for performance and recertification, the combination of good medical training and worrying abut one's patients is likely to lead to highest quality care.

Worrying about the patient puts the patient first not the doctor.

The 70s and early 80s were a time when we didn't worry about coding so much or E &M games. We spent more time talking about our patients and what was wrong with them medically and what we should do and attended no seminars on the best way to code. We did not use templates to treat the charts and we didn't worry abut how to game the system so as to get pay for performance. Being bribed to do our job was not a concept that in our universe of discourse or of thought. We could worry about our patient because the economic reality of time allowed us to do that.

I feel sure-or at least hope-that the good doctor still worries about their patients but it seems all the other worries -like how to keep the practice viable and not be audited by CMS and somehow be stewards of the limited medical resources , or if you prescribed the "wrong "drug according to the patient's prescription plan, or if you had enough patients with a low enough Hb A1 C to not be delisted by the patient's insurance plan-may well encroach on the available worry time and energy . You can only worry about so much.

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