By James Ong, M.D., via kevinmd.com:
There was a time when doctors were doctors. There was a time when young men and women sacrificed the best years of their youth, learning to treat patients and conquer diseases, not to become typists, paper pushers, data-entry clerks, or to have hospitals, insurance companies, and the federal government dictate to us how to practice medicine.
There was a time when doctors were trusted. There was a time when we were not guilty until proven otherwise, as viewed by blood-thirsty bounty hunters like the wild dogs of the recovery audit contractor (RAC) unleashed by our ruthless federal government.
There was a time when doctor’s orders were meant to be orders. There was a time when our orders were not subject to endless scrutiny and nonsensical denials by HMOs, pharmacists, hospital formularies, insurance companies, and the federal government.
There was a time when doctor’s opinions were valued and recommendations were followed. There was a time when we were not routinely challenged by our patients, their families, their neighbors, hospital case managers, hospital administrators, medical officers of HMOs, or some random doctors on the other end of the phone 3,000 miles away.
There was a time when doctor’s progress note held useful information. There was a time when our writing contained constructive and consequential discussions on patient’s medical conditions, not a mere memo to be attached to the chart and artificially beefed up with worthless numbers, reports, graphs, and other meaningless rubbish created in anticipation of Medicare audit.
There was a time when doctor’s consultation note was a work of literary art — succinctly crafted and beautifully articulated to efficiently describe the patients and their diseases, and to effectively convey to the reader the well thought-through recommendations of its author.
There was a time when the reader of a medical chart did not have to scroll through 10 pages of repetitious, auto-filled, and computer-generated garbage mandated by the feds, the hospitals, and Joint Commission (JCAHO), only to get to an anemic, malnourished, and anticlimactic — albeit the most important — final section of “discussion and recommendation.”
There was a time when doctors actually wrote orders. There was a time when we did not have to go through 10 steps and 22 keystrokes on a hospital computer just to place a simple order like NPO, which would have otherwise taken 2 seconds with a pen.
There was a time when doctors actually saw patients. There was a time when we spent more time with our patients than with our computers — more time on listening to them than on training Dragon Dictation, typing notes, keeping up with meaningful use, writing rebuttals to RAC, drafting appeals to PPOs, filling out forms, updating problem lists, and reconciling medications on hospital EHR.
There was a time when doctors were welcomed by the hospitals and the communities they served. There was a time when hospitals assigned more parking spaces to doctors than to their own administrators. There was a time when there were no padlocks on the refrigerator in the doctor’s lounge.
There was a time when doctors actually utilized their brains at work. There was a time when practicing medicine was not just about completing forms, checking boxes, navigating pathways, meeting core measures, and predicting — before patients actually arrive at the hospital — whether they would be inpatient or outpatient according to Medicare rules.
There was a time when doctors spent more time thinking about patient care than pushing papers. There was a time when we did not have to sign more documents for a simple outpatient procedure than what is required on a home mortgage application.
There was a time when HMO was still a three-letter word. There was a time when JCAHO was still a five-letter word. There was a time when Obamacare was not a four-letter word.
There was a time when private health insurance was considered good insurance. There was a time when the acronym PPO was not used for blasphemy.
There was a time when patients actually paid their bills. There was a time when the words co-pay, deductible, and coinsurance meant what they truly meant, not some random numbers subject to inventive negotiation and crafty blackmail tactics by some patients.
There was a time when doctors were judged by their credentials and by their professional peers. There was a time when our medical school diploma meant more than the reviews on certain online social media intended for rating restaurants, plumbers, and prostitutes.
There was a time when young men and women went to medical school because having “M.D.” behind our names was the most honorable and respectable thing to do. There was a time when professional gratification for physicians was not an oxymoron.
There was a time when doctors were doctors, physicians, and surgeons. There was a time when we were not referred to as contractors, providers, or whatever other denigrating and demoralizing monikers insurance and government bodies choose to confer on all of us who have dedicated our lives to this once prestigious and highly respected profession.
There was a time when doctors were real doctors.
James Ong is a cardiologist.