Monday, September 20, 2010

Disconnect Between Private Medical Practice & Medical Education

It fascinates me that there is such a disconnect between the economic view of those in private medical practice and those in Medical Education or University Based Practices.  Recently read an interesting post by Bryan Vartabedian, MD, at 33 charts discussing the future and inevitable changes in medical practice.
It is my opinion that medicine is changing and the practice of medicine will probably be unrecognizable in the next 10-20 years.
Yes, technology is making the evidence of practice guidelines better and more effective, but that is part of the way medicine is changing.
Daily, I am barraged with "practice protocols and guidelines" from every specialty group and every expert committee (a full ream of paper is mailed to me daily from all these expert groups).  Insurance companies then accept these guidelines as the "gospel truth" and if I'm not following them to the letter, my paycheck is reduced.  The "art of medicine" is disappearing with the overlay of the flowchart and practice protocol or practice guideline.  But to earn my living, I have to either demonstrate I followed the protocol, or write an additional paragraph as to why the protocol is not appropriate for that patient.  It is impossible to do that 35 times per day even with the most efficient electronic medical record available (I know 'cause I have one).
But the educational system still appears to be teaching the students that the current evolution is the "best."  The student cry "foul" and question the experience of those who have been in the trenches and claim that the error is on the part of private industry.  This progressive view of medicine is killing the "art."  And it is in the "art of medicine" where the caring and compassion is found.
Medicine as we know it will change into an efficient, cold, assembly line of diagnosis and treatment dispensing, unless we collectively change it.  The enjoyment of medicine is found in its art.  Once that is gone, you will loose the great physicians.  You will have an industry of cookbook, cookie cutter practitioners dispensing the latest medial equivalent of the GM Volt. The government is driving this.  In my practice, 50% of my patients care is driven by Medicare in some capacity.  When you put the government in control of medicine your going to get more bureaucracy and less art.
What is the answer?  Time.  Only time will tell. Until then, we practice medicine the best we can with the tools we have and apply the art of that practice to each individual.

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