Beyond the Five-Digit Codes: The Art of Putting Patients First
By Steve Simmons, M.D.
Last week my partner wrote about The Funnel, and illustrated how patients are squeezed through a healthcare system that focuses on specific problems without allowing enough time to treat patients as individuals. We have shown how frustrating this is for doctors and demonstrated that a shortage of primary care physicians is a reality. However, we don’t believe it’s too late to reverse this foreboding trend. Today, my partner and I at doctokr Family Medicine are building a practice to care for our patients as individuals first. We have also added our voice to a growing chorus of physicians sounding ever louder, explaining the necessity of a healthcare system that places the art of caring for patients first.
The next time you sit in a doctor’s waiting room, look around and consider what, and more importantly who, you see. You might see a sick child or his worried mother. Our healthcare system does not see two people, rather it sees a 5-digit CPT and ICD-9 code. ICD-9 (International Classification of Diseases) codes were originally created by the World Health Organization (WHO) to track diseases across the globe. Today, CPT codes (designating patient difficulty) are combined with the ICD-9 codes by third-party providers to standardize the reimbursement process. Although over 17,000 ICD-9 codes exist to classify various illnesses, there is no code for compassion. More concerning, the system does not allow any time to ease the worries or fears of a mother.
The focus of a primary care doctor’s medical practice should be on the art of patient care. An individual should be treated as a whole and not the combination of their individual problems. But, a time may come when we must focus on one specific medical problem and seek the help of a specialist; such as an endocrinologist for diabetes or an orthopedist after an accident. Yet, without a primary care physician to coordinate our care and speak on our behalf, a patient’s wants and needs as an individual might not be considered in reaching a particular treatment decision. I can speak as a doctor, son, or patient when I say that anyone’s health can suffer at the hands of brilliant physicians working without the guidance of a coordinating physician who knows us well.
My mentor in medical school was an experienced family physician near retirement who offered me the following insight. There are two types of doctors and I would consciously or sub-consciously choose which one to be. One type of physician makes medical problems central in their patients’ lives and thus forces the individual to revolve around their problems. The other type works to keep the patient’s life central and tries to make problems rotate around the individual.
Those policy makers determining the future of healthcare should follow my mentor’s advice. Today’s health-care system has devolved to focus solely on problems and disease, often to the detriment of individuals and families. As decision-makers explore revamping our current healthcare system they could continue, unaware, in this same direction. But, I have to believe they would choose the other direction if they could remember how it feels to sit in a doctors waiting room surrounded by other people - individuals all. Nothing will change the fact that healthcare is ultimately about people, and not codes or a specific problem. Healthcare should help patients and their primary care doctors make good health and wellness decisions while basing them on an individual as a person.
Until next week, I remain yours in primary care,
Steve Simmons, MD
Any suggestions on how to motivate physicians or other health care practioners to focus more on treating the whole patient rather than focusing on the medical problems and forgeting about the patient as a person? Likewise, how do we motivate patients to become proactive and involved in their own healthcare to the level needed to be willing to share their lives with their physician to help him understand who they are? Would personal health records open up this sharing between physician and patient allowing each to learn from the other? Would not this interaction between physician and patient be to the benefit of both resulting in better care?
Any suggestions on how to motivate physicians or other health care practioners to focus more on treating the whole patient rather than focusing on the medical problems and forgeting about the patient as a person? Likewise, how do we motivate patients to become proactive and involved in their own healthcare to the level needed to be willing to share their lives with their physician to help him understand who they are? Would personal health records open up this sharing between physician and patient allowing each to learn from the other? Would not this interaction between physician and patient be to the benefit of both resulting in better care?
Its a tough line to walk. I know a few physicians who have actually cared for a person as a whole, and tried there best to help, but have been criticized by colleagues and patients for being 'too caring', or 'too personal', while others complain that their doctor doesnt do enough. Where is teh balance
Its a tough line to walk. I know a few physicians who have actually cared for a person as a whole, and tried there best to help, but have been criticized by colleagues and patients for being 'too caring', or 'too personal', while others complain that their doctor doesnt do enough. Where is teh balance
I would trust most physicians to care for their patients in the best way available to them. As such, I believe freedom from today’s over-burdened healthcare model would be the best motivation possible; it is simply too difficult to think about the big picture when you are always hurrying and struggling to see more patients than you actually have time for. Any attempt to spur the average primary care doctor to ‘do better’ would likely fall on the deaf ears of a physician whose main struggle is seeing enough patients in a day to stay afloat financially. This is why we have arranged our medical practice outside of the current insurance model and a big reason why I, now, like going to work in the morning.
Motivating patients is a different question with the answer, for me, led by financial realities. What is meant by the term ‘preferred provider’? If it implies a relationship based on a list supplied by an insurance company, then finances are the most important aspect of this relationship and I would not count on this relationship to be very motivational. If a doctor is preferred because of a relationship built on trust gained through shared experiences with a clinician, then motivation moves beyond possible to probable.
I suspect you asked about the personal health records because this will motivate some people to become more proactive in their own health. Personal Health Records seem a natural and inevitable extension of the information age and I would be unwilling to argue against the power of this tool to open up sharing between physician and patient. I feel strongly that any interaction between physician and patient based on accurate information will lead to better decisions and better care. What is actually meant by personal health records is open to debate and I am watching our new administration with great curiosity on how the decisions they make will influence this concept.
I would trust most physicians to care for their patients in the best way available to them. As such, I believe freedom from today’s over-burdened healthcare model would be the best motivation possible; it is simply too difficult to think about the big picture when you are always hurrying and struggling to see more patients than you actually have time for. Any attempt to spur the average primary care doctor to ‘do better’ would likely fall on the deaf ears of a physician whose main struggle is seeing enough patients in a day to stay afloat financially. This is why we have arranged our medical practice outside of the current insurance model and a big reason why I, now, like going to work in the morning.
Motivating patients is a different question with the answer, for me, led by financial realities. What is meant by the term ‘preferred provider’? If it implies a relationship based on a list supplied by an insurance company, then finances are the most important aspect of this relationship and I would not count on this relationship to be very motivational. If a doctor is preferred because of a relationship built on trust gained through shared experiences with a clinician, then motivation moves beyond possible to probable.
I suspect you asked about the personal health records because this will motivate some people to become more proactive in their own health. Personal Health Records seem a natural and inevitable extension of the information age and I would be unwilling to argue against the power of this tool to open up sharing between physician and patient. I feel strongly that any interaction between physician and patient based on accurate information will lead to better decisions and better care. What is actually meant by personal health records is open to debate and I am watching our new administration with great curiosity on how the decisions they make will influence this concept.