Sunday, December 07, 2014

A starry-eyed premed student shadowed me the other day. And as much as I tried to show her to ropes, I felt guilty showing her the realities of practicing medicine in the USA.
Not only do doctors need to know and treat disease states, our roles have evolved in not-so-ideal ways to include other duties.
Like how the insurance companies expect me to know what is on their formulary drug list (ie what is preferred, or cheapest, for their members). Not only is this confusing enough as every company has a different preferred list, but the same company often changes in the new year. So this year they prefer Insulin A, but next year it's Insulin B, or C. In the meantime, when the new year comes along, we get faxes from the pharmacy or calls from the patients, that their med is no longer preferred.
Like how I spend at least 2 hours every week performing paperwork (not inclusive of charting since this isn't paperwork anymore, being on EMR). Signing prior authorizations, or writing letters explaining why that patient with thyroid cancer and increasing thyroglobulin levels need an iodine scan. Or why a patient needs to be testing his glucose 4 times a day.
And yet we play the unenvious role of defense lawyers. How it's no longer about clinical suspicion. Or simple trust. Like how when the patient tells me she isn't pregnant and I send her for a scan, the radiologist still wants us to do a pregnancy test, "just in case". Because her word isn't good enough, in case they get sued. Or how pretty much everyone who walks into the ER complaining of a tummy ache gets a CT scan. And you wonder why the USA spends more money per patient than anywhere else in the world, with nothing to show for it.
Or how I feel like I'm reduced to a secretary or record keeper. Needing to do stupid items to "meet meaningful use". To have my clinical notes explode into 4 pages, when I have only 2 paragraphs relevant for the referring physician- only to fulfil some quality measures that some bureaucrat with the IQ of a snail has decided to be important.
It's true that medical school and residency only teaches you so much. That in the first year of practice you really do have the steepest learning curve; when you actually come out into practice on your own, no longer shielded by attendings.
And so, after the half day of shadowing, I hope I didn't put the student off medicine. However it is true that being a doctor is getting way too complicated these days...

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