What would you change about the way medicine is practiced?

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Hard to come up with specifics but generally speaking I’d like physicians to be able to do more of what we are actually trained to do that nobody else can do. That includes all the various skilled procedures but more globally it means complex thinking and synthesis of multiple pieces of information with a human understanding of the person you’re treating.

I got a small taste of this in the middle of residency. We were changing EMRs and it was our first day with the new system and the whole thing crashed at 7am. Despite all assurances of reduced schedules, we had a full clinic too. For the next 5 hours we got out the old paper charts and it was by far the most enjoyable clinic I’ve ever done. I saw patients, jotted down key points, handed the paper to my attending who made a brief summary and attestation, handed it to the MA along with paper orders for whatever was needed. The staff called and scheduled scans and return visits and the like and my attending and I just saw patients and did procedures. At lunchtime we had finished on time and all our documentation was finished.

The new EMR went live at lunch and the afternoon was like every clinic since. I’m a tech savvy person and am efficient with EMRs, but in the end it means a big chunk of time is spent doing things that don’t require an MD. I’m so thankful to be a surgeon where at least I have the OR and procedures that I can spend my time thinking and doing what I’ve been trained to do.
 
realistically there needs to be significant tort reform. On my IM rotation it is astounding how often consultants are called. Anyone needs an antibiotic? Call ID
 
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I require a 100% salary reduction and an immediate kicking to the curb of all administrators

Completely eliminate all independent practicing of midlevels

Permanently ban the use of the word that starts with p and ends with ider

Require all insurance companies to approve necessary treatments immediately

Remove all unnecessary paperwork BS

Destroy all inefficiencies

If this can be done, I guarantee a quality of life increase of 300%
 
AnatomyGrey12 said:
I think they are making a joke about corn kernels in the colon.

As for the topic of the thread, I would start by having an EMR designed for physicians BY physicians. Instead of this garbage we have that is purely for billing purposes.
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U know what, I got a uworld question wrong because of that corn restriction in diverticulitis. Apparently the kernels dont get stuck in diverticula.
 
AnatomyGrey12 said:
As for the topic of the thread, I would start by having an EMR designed for physicians BY physicians. Instead of this garbage we have that is purely for billing purposes.
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I used to work for Epic (the EMR) and they totally think they are God’s gift to medicine haha lots of koolaid being drank there
 
libertyyne said:
U know what, I got a uworld question wrong because of that corn restriction in diverticulitis. Apparently the kernels dont get stuck in diverticula.
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There’s actually a whole section in the uptodate article on diverticulosis on that very topic and how there’s no evidence to support telling patients to avoid corn and ****.
 
Matthew9Thirtyfive said:
There’s actually a whole section in the uptodate article on diverticulosis on that very topic and how there’s no evidence to support telling patients to avoid corn and ****.
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i was presenting a diverticulitis patient the to the chair of the IM department , well respected, well seasoned clinician. First question he asked me was if the patient had ate any corn prior to the event.
 
libertyyne said:
i was presenting a diverticulitis patient the to the chair of the IM department , well respected, well seasoned clinician. First question he asked me was if the patient had ate any corn prior to the event.
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Welcome to how medicine works.

Sarcasm aside, this actually is a valuable lesson.
 
libertyyne said:
i was presenting a diverticulitis patient the to the chair of the IM department , well respected, well seasoned clinician. First question he asked me was if the patient had ate any corn prior to the event.
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Dogma dies hard.
 
operaman said:
I got a small taste of this in the middle of residency. We were changing EMRs and it was our first day with the new system and the whole thing crashed at 7am. Despite all assurances of reduced schedules, we had a full clinic too. For the next 5 hours we got out the old paper charts and it was by far the most enjoyable clinic I’ve ever done. I saw patients, jotted down key points, handed the paper to my attending who made a brief summary and attestation, handed it to the MA along with paper orders for whatever was needed. The staff called and scheduled scans and return visits and the like and my attending and I just saw patients and did procedures. At lunchtime we had finished on time and all our documentation was finished.
Click to expand...
On my FM rotation, this was exactly how the doctor operated. Paper charts, scribble orders on them, hand them to the MAs to do all the ordering etc. They'd field any phone calls from patients/pharmacies/etc, pull the chart, write what was being asked, and leave them stacked on the doctor's desk. Doc would scribble back "yes/no/ok change to crestor 20mg" and put back on the MAs desk to get it done. I thought it was archaic when I first started, but it was actually really nice. There was actually time in the appointments to talk to patients and focus on being a physician. On my surgery rotation the doctors had scribes in clinic, which was also pretty cool.
 
fldoctorgirl said:
On my FM rotation, this was exactly how the doctor operated. Paper charts, scribble orders on them, hand them to the MAs to do all the ordering etc. They'd field any phone calls from patients/pharmacies/etc, pull the chart, write what was being asked, and leave them stacked on the doctor's desk. Doc would scribble back "yes/no/ok change to crestor 20mg" and put back on the MAs desk to get it done. I thought it was archaic when I first started, but it was actually really nice. There was actually time in the appointments to talk to patients and focus on being a physician. On my surgery rotation the doctors had scribes in clinic, which was also pretty cool.
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That sounds just awful
 
I'd take a page from lawyers and make it illegal for anyone without a medical license to own a practice and enforce prosecution of practicing medicine without a license to the fullest extent of the law, with revenues from fines going to the state board.
 
Yeah having worked in a couple places (EM docs and Ophthos) with scribes I think that’s the way to go. Your time as a physician is worth way more than that nonsense
 
VA Hopeful Dr said:
That sounds just awful
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Paper notes are great. I love when cash psychiatrists fax me their notes. The notes appear to span 20 years but are composed of a total of 5 pages. Each page is mostly blank except for maybe the date (I think) and what appears to be a single a-fib tracing in the middle of the page.
 
Candidate2017 said:
Paper notes are great. I love when cash psychiatrists fax me their notes. The notes appear to span 20 years but are composed of a total of 5 pages. Each page is mostly blank except for maybe the date (I think) and what appears to be a single a-fib tracing in the middle of the page.
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I'm sure they're fine for specialists but most of my patients come in for 5+ issues each appointment. EMR is way better at keeping up with complex patients like that.
 
Candidate2017 said:
I'd take a page from lawyers and make it illegal for anyone without a medical license to own a practice
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What are the current laws around ownership of a practice? I assume it varies by state, but thought they already had to be physician owned.
 
Kardio said:
What are the current laws around ownership of a practice? I assume it varies by state, but thought they already had to be physician owned.
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They are state specific, though I'm not aware of any state that restricts practice ownership to licensed physicians. Hence corporate groups buying up ED and anesthesia groups, Wall Street buying derm practices, hospitals buying up primary care practices (and making lots of money from facility fees and referrals to their hospital-owned imaging centers/employee specialists/labs/pharmacies etc, But independent physicians are barred from doing so under federal Stark laws.

Med students/physicians have a very poor understanding of their value due to nearly a decade of getting bashed and stepped on during training, such that the transition to brow-beaten employee (instead of fully licensed professionals granted a government monopoly to ply their trade independently) is comforting.

I am looking for attending outpatient jobs and most of outpatient psychiatry clinics are owned by psychologists, NPs and/or social workers. They want a laughably high cut of my billings for a low overhead specialty and what amounts to an office and someone answering the front desk. But it's sad, sad, sad because a few of my attendings actually are contractors for them.
 
Personal assistants for all resident teams on the floors.

One nurse for every patient.

Separate high-speed elevators only for doctors.

Combination MR/CT scanner that full-body scans every patient entering the ER.
 
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