Sunday, August 26, 2007

Physician Mindsets - Unconventional Wisdom

A close friend of mine, Dr. Don Copeland, who has been a solo family physician, organizer of a large FP group, and co-creator with two other FPs of the a family medicine program at Bowman Gray Medical School, and I were venting our feelings about the sorry state of medicine in the clinical trenches the other day. Don lives in Cornelius, North Carolina.

He made the following comments, which I paraphrase from memory.

• “ I hate the term ‘primary care’ almost as much as I dislike the word ‘gatekeeper.’ I told people in the beginning these concepts wouldn’t work, and they haven’t. I much prefers to call family physicians ‘personal’ physicians, for that am exactly what we are. We’re ‘personal’ doctors. We know our patients personally, advise them, and guide them. We’re not intermediariies for some specialist or lackeys for some insurance company.”

• “The medical schools don’t get it. They treat as secondary citizens. They don’t realize we’re on the frontlines, and we’re just as important, if not more so, than their cherished faculties of specialists. Some of the major academic centers, like Harvard and Johns Hopkins, don’t even acknowledge that the specialty of family practice exists. They think everybody goes to their internist first. “

• “The people who design these pay-for-performance programs, quality indicators, clinical guidelines, and physician profiles have never been in practice. They’re not really doctors. Most of them are medical bureaucrats who have never been there and done that.”

• “People don’t come into the office with a diagnosis pinned on their foreheads. You have to listen to them, understand their social and work situation, and know them as friends, neighbors, and members of your community. Sure, you can follow these “metrics” once you know what going on and have established a diagnosis. But that’s child’s play. Anybody can do follow guidelines once the diagnosis of hypertension, diabetes, thyroid disease, or some mental disorder has been established. But it’s getting to the diagnosis that counts. The skill in establishing a diagnosis is just as important as tracking and monitoring patients with an established diagnosis.”

• “These young doctors who are selling out to hospitals don’t understand they are handing over their license to practice medicine to the hospital. They also don’t understand that hospitals will demand that lab tests, x-rays, and other tests or procedures be done at the hospital -- at grossly inflated prices over what they could be done on the outside. Hospitals have negotiating clout with hospitals, Doctors don’t.”

• “When I read new types of innovative practices they all write about same day access, better communications with patients, computerized medical records, ‘medical homes,’ ‘team practices,’ use of non-physicians for routine care, but none write about The need to strengthen the doctor-patient relationship.”

• “There is no other profession as personal as the medical profession. If physicians continue to allow non-physicians for routine care, and hospitals and insurance companies to control them, they will lose their patients and will nothing more than over-educated hired technicians.”

• “Our best hope is for doctors to embrace health savings accounts, endorse high deductible plans, and to deal with patients on a personal basis rather than through remote third parties who don’t have the slightest idea about what being a personal doctor is all about. To back my beliefs, I founded HSA Healthcare, Inc, a PPO devoted to educating patients, physicians, employers, and community banks about the benefits of HSAs.”


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