Just Another Anachronism

 black and white water wheel grist mill 

Sometimes I get writers block. 

Something so big, so upsetting happens and it is all I can think about for days or weeks. Everything else is crowded out of my brain until I find the right words to talk about it and get it off of my chest.

This is now.

First, you need to know that the hospital system that I work for requires all employees who use the system’s insurance to only see providers inside that system.

Last week employees of the system received a postcard or email telling them that the system was encouraging everyone to start using evisits for certain things like sinus infections, bladder infections, pink eye, allergies, etc.

This is upsetting enough, because to be honest a lot of these things can be treated (for free) by phone and don’t require the cost of an evisit. I treat a ton of stuff by phone for my patients, but if you call about a sinus infection and you have out of control diabetes and have not been keeping your follow-ups, I am going to use this opportunity to make you come in to see me so we can address both. But these evisits are not done by me or anyone in my office. They go to evisit providers in some mystery room in the sky. I never see or hear about it until after the fact. My patients are being “seen” and treated by people that I know nothing about and have no control over.

These evisit “providers” are apparently not using the EHR. I have no idea how much access to the EHR they even have, how much of a patient’s history can they see. For instance, do they know that a patient with recurrent bladder infections was just treated two weeks ago and that the culture grew a bug resistant to most antibiotics? 

But what really gets me is that the emails and postcards were sent out to patients personalized with the name of the clinic where their primary care physician works as if #1, their PCP is administering this service and #2 approves of it. 

There was no warning about this. Or rather, there was, in the form of an email that was sent a few days before to office managers, and not directly to physicians, that said it was going to be done, an email I was not aware of until after the fact. 

Don’t I warrant some direct notification? These ARE my patients you’re talking about, you know….

I am really struggling with this loss of control. It feels that with each passing day my relationship with my patients is being undermined further. Patient care will suffer when you exclude their primary care physician.

Why can’t we do evisits the right way? I want to scream this to the deaf ears above. 

Listen to me!

They do not care how angry I am. 

My vision of healthcare is an anachronism, it belongs to the past. The message being sent is to accept this brave new world or go extinct. 

Join the new virtual reality…

What is going to be left of me, of primary care, when all is said and done?

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134 thoughts on “Just Another Anachronism

  1. The more you write about your health care system, the more alarmed I am. It doesn’t sound like health care at all … except for the insurance company.

    Many years ago, our VP Sales was quite annoyed with me about something (I was VP Finance). He said ‘God help us if the accountants ever run the company because the voice of the customer will be lost”. I was deeply insulted at the time, but I see now he had a good point.

    Liked by 1 person

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