My finger hovers over the smoking history tab…
Do I click current smoker?
I could lie. Maybe I “accidentally” forgot to hit the right button?
No one would ever know.
Except it does not acurately convey his risk factors. It would not trigger me to ask about if he was ready to quit yet at his subsequent appointments. Not to mention the fact that it is a LIE.
I don’t want this to count against me! It isn’t my fault. I didn’t light up that cig and hand it to him, you understand.
“Are you ready to try quitting again?”
I don’t get credit for asking, though. I don’t even get credit for recommending cessation. I only get credit for clicking the nonsmoker status.
Why did he have to start smoking again, damn it?
Today I found myself looking at another patient’s hemoglobin A1C (a measure of diabetes control) when I was deciding about firing her for a completely unrelated issue. What should that have to do with it you may ask? I realized I was more likely to fire her if she had a bad A1C.
Because of those numbers the suits are tracking….
You know what?
I don’t want to be like this. It is not why I got into medicine. This isn’t helping people.
And I don’t want lies to ever come easily for me.
If there is one thing that blogging has taught me, it is that when I think I am alone in something, I am not. Even when it comes to pulling on my eyebrow hairs when I am stressed out. So how many other physicians out there are feeling the same pressures? How many others are finding themselves faced now with these moral/ethical delimmas?
More importantly, what about patients? Faced with rabid physicians trying to keep their numbers up, are they being less truthful with their doctors? Did they really get that immunization? That colonoscopy? The mammo? Or do they say yes just to shut us up?
If they lie about it, I’m off the hook, right?
And why can’t patients make their own decisions about what is right for them? What makes ME or any other doctor absolutely right in all things? (Particularly when we keep changing our own guidelines?)
What about the patients that are fired for not getting their screenings done? Who is going to take care of them? Don’t they deserve the same access to care as anyone else?
Humans have the right to make bad choices.
I should be able to make the screening suggestion and facilitate getting it addressed but beyond that, I don’t want to feel like I am wrestling a patient to the ground and punching them in the face until they give in to keep my scores up. I can be *very* persuasive, but my oath was first to do no harm. Harm comes in many forms, something not reflected in those numbers.
Ultimately, this is the way of medicine right now. I don’t see it changing any time soon. That won’t stop me from mounting my own mini rebellion, though. I won’t let them change me into something I detest…
My mind turns back to the computer screen. I click the current smoker option and carry on with the visit…