The National Association for Medical Direction of Respiratory Care


In previous blogs, we have heard about respiratory medical conditions and their effects on our patient population. This blog is a little different. It is about the loss of the human factor in patient care and the dangerous path our country is taking trying to automate every part of our medical system and our patients’ lives. The opinions that follow are my own.

Two events have guided me to write this blog. The first is a recent conversation I had with a newly trained hospitalist. In that conversation, we spoke about the changes that have occurred in the last decade of medicine. Since I happen to be one of those physicians who derive great joy and personal satisfaction from spending time with my patients, I am a relative outcast among my peers. This doctor asked me directly, “Why do you waste so much time talking to patients?” I’m sure there are a few of us out there who see the danger and disappointment in that question. The second event is directly related to the first. I have found myself in the sad situation of having to begin an early retirement process. After more than 25 years of pulmonary/critical care and sleep practice with a great love of my field, I am no longer able to practice the way I was trained. During my fellowship years, I had the distinct pleasure of meeting and subsequentlyidolizing Dr. Roger Bone, who in life and death continued to inspire me to care for the patients as much as the knowledge of medicine.

So, at the ripe old age of 54, I can no longer continue to support a private pulmonary practice and still spend time with my patients. My time is now consumed by fighting for every prescription I order, unnecessarily repeating many tests/procedures based on new insurance requirements, documenting over and over the needs for oxygen, PAP and nebulizers and the many other random insurance requests (aka stalltactics) that clog up my after hours. I know I don’t need to go on because many of you readers are shaking your heads. There are countless writings out there about our medical practice burdens. Hospitals and insurance companies are taking great advantage of doctors’ self sacrificing nature and just wearing most physicians down with all these burdens to providing care. Many believe this to be a conspiracy.

I happen to believe that our country is moving into a different age of medicine. A time that is controlled by executives at insurance and pharmaceutical companies and their bottom line need for profitability at the expense of everyone else. Our EMR systems are an example of this. These systems are set up to perform best for the needs of the organization controlling their implementation, not the needs of the patients or physicians caring for them within it. I predict that the subtle and progressive movement to rid our medical system of doctors will ultimately result in kiosks located in shopping malls and grocery stores to diagnose and treat based on a set of predetermined symptom algorithms. I have no idea how anyone can stop this movement. Many physicians have already left the system because of these factors.

As we all know, not every patient with a named disease behaves exactly the same way. This is where the human factor is greatly lacking. Not every patient with COPD fits into the same template. This is also the reason why the powers that be in the insurance companies, hospitals and pharmaceutical companies will never understand how or why the automation does not work. They’re all focused on the technical…NOT the medical! Consider the following: Pulmonary doctors deal with dyspnea all the time. One of my favorite parts of teaching patients as a pulmonary rehabilitation director and in my own practice has been to review non -pulmonary situations where their breathing can be negatively affected. If I spend the time talking to them, I can often uncover a reason for their increase in dyspnea that does not require inhalers or steroids to fix. Patients are people first, patients second. After a weekend on call, I was signing out one Monday morning to my colleagues on the events of the weekend. As I was relaying the course of a particular patient my partner asked me how I knew such detailed psychosocial information that he was unaware of even after taking care of that patient for years. So I answered: I asked him.

Taking the time to talk to, care for and understand our patients is the human factor that is so imminently threatened by our new system.Everyone is rushing and stressed, patients are being ignored for the sake of documentation, our practice style and structure is constantly being threatened, we all need to find some work/life balance, we are making less to do more non clinical work, we are working for free or hiring unmotivated, untrained assistants to document critical data the insurance companies demand from us… only so they can find yet another way to pay us less for what we are doing. The machines are taking over because we humans cannot work 24/7. It’s frightening tothink of how WE will be cared for in the future.

I am grateful to be part of such a dedicated organization as NAMDRC. It is a daily battle to see these burdens limited and access to quality pulmonary care assured. The dedicated staff of this organization lives and fights for this every day. Thank you to all of them. I hope this blog stimulates some interesting conversations!

Valerie Schneider M.D. - Walnut Creek, CA

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