Getting Trapped Doing the Right Thing

One of the docs I had the privilege of working with back in NC pointed out a blog  post regarding how doctors are trapped (paid).  It's a good quick read and describes the (inefficient) system which we have set up for ourselves.  I don't remember too much of my Econ 101 (sorry!) but I suspect that this is what happens when you don't allow the free market to have its way (my overly simplistic interpretation).

But enough of that.  My point of this is post is to recall a conversation I had with one of my 2nd year (PGY-II) residents yesterday in which I suggested that rather than spending all his/her time going into all the details of a patient's very common problem and then list a variety of therapeutic options, perhaps s/he sh/could focus a bit more on the bigger issue of the patient's overall health and chronic conditions.  I think this is especially important for the vast majority of Americans (young adults & middle-aged men) who only visit their physician when they have an acute issue but fail to follow up the chronic conditions that will end up biting them in the behind decades later.  

So rather than ignoring the diabetes, hypertension, and dyslipidemia, and avoiding a review of the attendant medications & labs, I encouraged the resident to address those concerns even though they were not part of the patient's "chief complaint".  Don't get me wrong - we still have to address the reason that brought the patient in to see us.

Will the School of Medicine get paid for this "extra" work?  Maybe (if we document appropriately to support & bill to a higher level of care).  Maybe not.  But at the end of the day, shouldn't we do the right thing, even when no one's looking?  After all, we're physicians.  It's our profession.  But who's going to look out for us (our practice/business) when we can no longer afford to give away free care?  Are we trapped?

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