Our medical training has been outsourced

by | July 18, 2019

KATIE KLINGBERG, MD | PHYSICIAN | JULY 15, 2019

Reflexively, I often feel my breath catch, and my eyeballs roll ever-so-slightly when a patient leads with, “I saw on the internet …”

The precious minutes available to connect, inspect, and direct the management of their Google search are suddenly squandered by backtracking to reassure the bug bite will not turn into the bubonic plague!

Our medical training has been outsourced to Wikipedia and WebMD.

Today we all stand guilty believing we are experts in every area because we have access to the world wide web. We are a culture of information overload. We all want it quick, and we want it now.

What separates the gifted Internet sleuth from a true expert?

I believe it is the filter the expert possesses from his or her additional training and experience that is integral to connecting the dots and creating a context.

Many industries have minimized the need for this filter. In our world where the customer is told unequivocally with a smile, “Have it your way,” we forget health care is not a hospitality business nor should it be.

The patient experience today has superseded sensibility.

Administrators spend too much time focused solely on the satisfaction of the patient. Was the patient greeted warmly when they arrived? Were they roomed in a timely fashion? Did the physician address and resolve all the issues they came in to discuss? Some administrators have become afraid to ask the patient to arrive early in case the doctor is running behind. Some insist a clinic never turn away a late patient or fire a chronic no-show offender. There are no longer checks and balances, no code of conduct, no basic expectations of the patient. We have gone soft acting like a new restaurant or hotel in the neighborhood that is not going to survive if we do not fall over our feet to “wine and dine” our high-maintenance patients every chance we get.

If the patient leaves happy, have we always done a good job?

If the patient is unhappy, the administration frets we will have bad ratings on Yelp, Nextdoor, or Facebook and start to lose customers. A fraction of my pay is actually docked if we get too many negative reviews regardless of the reason. We frequently run into the drug seekers and those who believe an antibiotic cures all. If we say no to the unnecessary pain pills or try to explain a virus never requires a Z-Pak — the physician suffers, and burnout ensues.

The sanctity of the physician-patient relationship is wavering. We are being poised in this business model of health care as the disposable middleman and as the element to be eliminated rather than revered. Are face-to-face visits a thing of the past?

My own organization’s CEO opined that half of the visits in primary care do not need an office visit. Meanwhile, medical schools spend a lot of time teaching the importance of the patient interview and relationship and the physical exam. Who is right?

There is a huge disconnect between the business of medicine and the art of medicine. Whittling down or eliminating the human component of medicine is worrisome to me. Technology has allowed online programs to emerge, allowing the patient to punch in symptoms and get that on-demand antibiotic they hoped for to treat a self-diagnosed urinary tract infection or sinusitis.

Taking the expert out of the equation is dangerous when the algorithm used cannot discern if the UTI is really a vaginal infection or an early indicator of a kidney stone or bladder cancer.

The sinus infection could be a bad tooth or a possible tumor.

Amazon Prime, Netflix, and DoorDash have created an unrealistic expectation that we can have everything we desire on demand at any time if we are willing to pay for it. In medicine, diagnoses often need to evolve, sometimes need follow-up, may need monitoring, and many need time called “watchful waiting” to see if the body will heal on its own.

Please remember — I, too, am a patient. I demand efficiency, a good relationship with my medical team, and answers when I am not feeling well. I always show up early. I do not want to come in if I can avoid a visit. I doublecheck my medical bills to understand the charges I have received and how my high deductible plan works. I lament the cost of health care and am disgusted by the prices I pay.

Being on both sides of the physician-patient relationship, I have ideas as to what works and what does not. My feet are pounding the pavement in a system that does not want to hear from me or truly value my expertise.

I harken back when the old, now-retired family doctors recall being an intrinsic part of the community making house calls and sometimes paid in potatoes or apple pies. Everyone was clear on roles and responsibilities, and no one was as self-certain and self-absorbed as our fast-paced world has made us today.

I cannot figure out who I am or what role I play. Can I use my hard-earned expensive filter or do I simply please and appease? Today, I am a factory line worker — with foremen who will not keep the patients moving on the belt in a timely fashion. But when there is a bottleneck, I am blamed. Tomorrow I will be the mechanic asked to service the car brought in for a 50,000-mile checkup. But wait — would I also install new wipers and fix the broken side window? Yet be forewarned, the customer does not want to pay for those extras and will complain! Or am I forever the fast-food worker managing individualized orders of each person driving by demanding a burger with two all-beef patties, special sauce, no lettuce and — wait — would I hold that sesame seed bun?! Because, of course, the customer recently read keto is the new fad on the internet!

Katie Klingberg is a family physician.

https://www.kevinmd.com/blog/2019/07/our-medical-training-has-been-outsourced.html

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