I have been toying with the idea of having my MA take the HPI. It would save time and allow me to see more patients. Also, I had to let go my NP and am about to search for another. As I consider these things and ponder some of the happenings in medicine (retail health, botox ads, boutique medicine) it seems like what it means to be a physician is changing.
I think we have to strongly consider what these things do to the public's trust in us. In medicine there is an unwritten contract whereby we are charged with taking care of people. I think tht as we redefine what a doctor is we have been slowly eroding that trust. For example, offering botox in your office shows that you really prioritize money. I would not trust a doctor who does that as much as one who does not. Perhaps even having a NP (in some cases) puts out the wrong message; if a less trained person can do your job why should I pay more to see you?
The main reason for most of these things is money. Perhaps the main reason is that we have an insurance system and run away healthcare system the end result of which is that salaries in primary care are pressured downward.
I think that we have to dial ahead to the end of our careers and decide today what we are going to do that will affect how we feel tomorrow. I do not want to have regret or feel like I prioritized things that in the end don't matter to me. Anyway, I am probably rambling too much but curious to see what others think.
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
Yes,
But what are the alternatives.
EMR is not good for this. It requires a entire new set of procedures to create a note that albeit expensive took little time to generate for the physician.
Now the Doctor is not even going to ask the pateint what is wrong with them and talk to them at all.
It already has been limited, I think talking to the patients is important to get a better diagnosis. I don't think your nurses can do this and still give you the feel you desire as a man who really does care about patient outcomes, Dr. K.
Humans communicate in varying ways. For sure, trhe words we use tell the story but the subtle cues of the HPI are important also. Plus, they tell the examiner what other questions to ask.
For example, a woman came in with a UTI. She turns out to have atrophic vaginitis secondary to menopause and she is having pain with intercourse. She was uncomfortable speaking of these things and it turns out that she is worried about not having sex as she thinks it has affected her marriage. She also is worried about HRT because of a personal hx of breast ca and to add to the problem she feels like her prior breast sx already impacted her sex life.
Good luck getting at this with IMH or an AM doing the HPI. All you will get is that she has a UTI.
Stick to your principles. Do what you were trained to do and care for people the way you would want someone to care for your child and you'll be able to sleep at night knowing you're fulfilling the solemn oath you took when you graduated med school. Whenever faced with a challenge, just ask WWAD or WWOD?
What Would Aesclepius Do? or What Would Osler Do?
DrK: I have been toying with the idea of having my MA take the HPI. It would save time and allow me to see more patients. Also, I had to let go my NP and am about to search for another. As I consider these things and ponder some of the happenings in medicine (retail health, botox ads, boutique medicine) it seems like what it means to be a physician is changing. I think we have to strongly consider what these things do to the public's trust in us. In medicine there is an unwritten contract whereby we are charged with taking care of people. I think tht as we redefine what a doctor is we have been slowly eroding that trust. For example, offering botox in your office shows that you really prioritize money. I would not trust a doctor who does that as much as one who does not. Perhaps even having a NP (in some cases) puts out the wrong message; if a less trained person can do your job why should I pay more to see you? The main reason for most of these things is money. Perhaps the main reason is that we have an insurance system and run away healthcare system the end result of which is that salaries in primary care are pressured downward. I think that we have to dial ahead to the end of our careers and decide today what we are going to do that will affect how we feel tomorrow. I do not want to have regret or feel like I prioritized things that in the end don't matter to me. Anyway, I am probably rambling too much but curious to see what others think.
Sorry to hear that your NP didn't work out for you.
In our case, using physician extenders was NOT about money. We had a PA, and unfortunately her family convinced her to move back to her previous city.
We did not make any extra money having her with us, it was almost break even.
Rather, we were getting really tired of hearing complaints time and time again from referring doctors and existing patients that we could't get them in soon enough for appointments. The referring docs would call us and beg us to see patients. We would do so, but then make our existing patients mad when we were running late as a result. Our families were upset that we were never home.
Having a PA was a breath of fresh air for us. She could do the routine rechecks quite well. If something was not right, she would simply grab us and have us pop into the room and evaluate the situation. This enabled us to see the new consults that we had been putting off. They could be seen in a more timely fashion now, making the patients and their referring doctor happier. We enjoyed the infusion of new patients, and we were able to get home a little earlier.
Perhaps some offices make money at this, but having a more enjoyable practice was worth the effort. We never expected to make much money at it. Since we never had that expectation, we weren't disappointed about the financials.
I have to add that the patients will often tell your PA or NP things that they WON'T tell you. Perhaps we are viewed as too powerful, or too likely to get mad. For whatever reason, patients seeing both the PA and MD get the best of both worlds. Now that our PA is gone, all of our patients miss her.
Reddy
William "Reddy" Biggs, MD Endocrinology Amarillo, Texas
Unbiased and independent, YES!
"Live on eClinicalWorks since 2/1/2007" http://tinyurl.com/ywqd49