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Practicing Primary Care: A Lesson In Treading Water

As a primary care physician, I am becoming painfully aware of how hard it is to be good –- I mean really good — at what we do today. I would prefer to believe that it has always been so, yet I do not believe that our predecessors in the medical profession found it nearly as difficult to excel in their time as we do now.

With all of the technological and medical advances, you might ask how I could believe this to be true. Too, you might consider it pessimistic or even crazy to suggest that physicians 20, 30, or 100 years ago found it easier to practice medicine well in their time.

You could counter with numerous or obvious examples such as antibiotics, pharmaceuticals, robotic surgical procedures, or even our wondrous ability to peer inside the human body without cutting it open. You also would be correct to point out that the technological advancements of the 20th century opened the way for the medical profession to become a real science thus giving me and my colleagues the chance and knowledge to make a real difference in our patients’ lives today.

Yet, none can benefit from knowledge they and their doctors lack, so time studying science is a requirement for physicians wishing to properly wield all of this lifesaving technology. Unfortunately, this time is currently needed to learn ICD-9 and CPT codes (with ICD-10 and 10,000 new codes coming soon) or to scour the HHS ruling just released defining “meaningful use” in the practice of medicine.

It would be hard for many to believe that some larger organizations are required by OSHA to actually have their physicians spend time filling out yearly paperwork reminding them to wash their hands or pointing out that needles are sharp and might transmit HIV. This seems to me the equivalent of making an employer remind an electrician not to stick his wet finger in the socket.

Fifteen years ago, my first office was next door to a hospital where I was granted privileges to perform a multitude of invasive procedures including intubations, bone marrow biopsies, and the placement of central lines. An average day would start and end with hospital rounds, with office appointments sandwiched between, and, if I was lucky, a medical conference at lunch time would provide both food and education.

Today, many internal medicine residents choose to either become a hospitalist or to practice only outpatient primary care medicine. And statistics show that patients have better outcomes and shorter hospital stays under the care of a hospitalist than a general “old-fashioned” internist — a trend that points out the challenge today’s primary care doctor has in keeping up in his field while not spreading himself too thin.

Furthermore, the inordinate and incessantly growing amount of time spent on cutting or avoiding the red-tape spun by innumerable government rules and regulations monopolizes our time and makes it difficult to find the time or energy to pursue further medical education.

I believe that some of these restraints preventing us from practicing medicine to our true potential are unique to the primary care doctor and this is, precisely, why many can describe us as “endangered.” It is all most of us can do just to keep our heads above water each day- leaving little time for study and less for research. The Hippocratic Oath I took included the promise to protect the noble traditions of the medical profession — a promise, in my estimation, that is growing harder to keep with each successive Congress.

Until next time, I remain yours in primary care,

Steve Simmons, M.D.

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One Response to “Practicing Primary Care: A Lesson In Treading Water”

  1. Art says:

    With a shortage of primary care physicians the governemnt is moving quickly to replace the shoartge with Nurse Practitioners and Physician Assistants, evidently not seeing that much difference between them and wanting to deliver on the promise of access and affordability.

    It is sort of the Marie Antoinette saying in reverse “let them who eat cake or have nothing at all to eat – eat bread”

    Since NP and AP have limited authority only by having them treat small problems not needing a physician and having the now practicing primary care physicians move to a specialty does the system now in place ahve any chance to achieve anything “meaningful”.

    Having 10,000 mor codes only allows a finer degree of miscoding to increase waste, fraud and abuse!

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