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    Opinion: Doctors are lazy

    Doctors are lazy. That’s a brazen, derogatory, declaration that contradicts the usual lofty public image of physicians. We are perceived to be hard-working, dedicated and long-suffering individuals who care only about improving and maintaining the health of our patients. But I contend because of anecdotes shared by my patients and from personal experience, doctors seemingly do everything we can to avoid close interaction with the people we are Hippocratically obligated to serve. We simply have gotten complacent about our role and the importance of meaningful interaction with patients and choose to keep people at arm’s length. Sometimes we don’t even see the patient.  


    During the nearly 40 years I practiced family medicine, not a week went by when a patient didn’t tell me about their experience with other physicians. “You know doc, he wasn’t in the room five minutes.” Or, “he never examined me” What? A physical exam is one of the basic components required for the determination of a diagnosis, and it was omitted?

    More inside: Insurance execs' salaries inflate healthcare costs

    I know the physical exam takes time; you might have to wait for the patient to get undressed, or you might have to put on exam gloves. But that exam often provides surprisingly important information you would have otherwise missed. Atrial fibrillation, hepatomegaly, melanoma, DVT, pleural effusion, and murmurs are just a few of the problems easily detected by taking the time to examine the patient. So come on docs, let’s do our job. Examine your patients. They depend on us to do right by them.

    Next: 'And then there's the monstrosity called electronic health records'

    22 Comments

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    • Anonymous
      Agree with most of comments especially EHR. Since ERH I have almost no life since I am rarely able to complete the note while seeing my patients. Patient's don't like it and I practice in a rural area with outdated internet service. Unfortunately physicians were told that there were no exemptions to the EHR mandate. Also BC/BS had been pushing EHR for years and very likely would have dropped MD's who chose not to comply. This was the main reason I felt I had to get EHR since BC/BS is the largest insurer in my state. The cost has been outrageous, especially for a small town primary care MD. I would like to dump my EHR, but it is hard to justify since it was such a huge investment with the first program (All Scripts) pulled support in 1 yr and all of the new hardware that was needed. I am very disturbed by the use of physician extenders especially by their use by many of the specialists in our region. Many are placed in satellite clinics with little to no direct supervision. I am afraid that physician extenders will be the major providers for most patients in the future due to the impending physician shortage.
    • Anonymous
      Agree with most of comments especially EHR. Since ERH I have almost no life since I am rarely able to complete the note while seeing my patients. Patient's don't like it and I practice in a rural area with outdated internet service. Unfortunately physicians were told that there were no exemptions to the EHR mandate. Also BC/BS had been pushing EHR for years and very likely would have dropped MD's who chose not to comply. This was the main reason I felt I had to get EHR since BC/BS is the largest insurer in my state. The cost has been outrageous, especially for a small town primary care MD. I would like to dump my EHR, but it is hard to justify since it was such a huge investment with the first program (All Scripts) pulled support in 1 yr and all of the new hardware that was needed. I am very disturbed by the use of physician extenders especially by their use by many of the specialists in our region. Many are placed in satellite clinics with little to no direct supervision. I am afraid that physician extenders will be the major providers for most patients in the future due to the impending physician shortage.
    • Anonymous
      Agree with most of comments especially EHR. Since ERH I have almost no life since I am rarely able to complete the note while seeing my patients. Patient's don't like it and I practice in a rural area with outdated internet service. Unfortunately physicians were told that there were no exemptions to the EHR mandate. Also BC/BS had been pushing EHR for years and very likely would have dropped MD's who chose not to comply. This was the main reason I felt I had to get EHR since BC/BS is the largest insurer in my state. The cost has been outrageous, especially for a small town primary care MD. I would like to dump my EHR, but it is hard to justify since it was such a huge investment with the first program (All Scripts) pulled support in 1 yr and all of the new hardware that was needed. I am very disturbed by the use of physician extenders especially by their use by many of the specialists in our region. Many are placed in satellite clinics with little to no direct supervision. I am afraid that physician extenders will be the major providers for most patients in the future due to the impending physician shortage.
    • Anonymous
      Agree with most of comments especially EHR. Since ERH I have almost no life since I am rarely able to complete the note while seeing my patients. Patient's don't like it and I practice in a rural area with outdated internet service. Unfortunately physicians were told that there were no exemptions to the EHR mandate. Also BC/BS had been pushing EHR for years and very likely would have dropped MD's who chose not to comply. This was the main reason I felt I had to get EHR since BC/BS is the largest insurer in my state. The cost has been outrageous, especially for a small town primary care MD. I would like to dump my EHR, but it is hard to justify since it was such a huge investment with the first program (All Scripts) pulled support in 1 yr and all of the new hardware that was needed. I am very disturbed by the use of physician extenders especially by their use by many of the specialists in our region. Many are placed in satellite clinics with little to no direct supervision. I am afraid that physician extenders will be the major providers for most patients in the future due to the impending physician shortage.
    • Anonymous
      Doctors are not doing their job. I have been to a doctor who never touched me and other patients have told me the same about him. My current internest gives me an almost complete exam on each visit. I think the physical exam is so important. I can't count the number of cases of atrial fibrillation I have diagnosed by just checking the pulse. I'll never forget the days when we had no CT scans or MRI's and we had to really examine a patient to get a diagnosis. That's the way we were trained. I recently saw a cardiologist who did a 2 second auscultation of the heart before telling me I needed CT angiography of the heart and then a cardiac cath. Doctors now don't think of going into private practice. They all want an 8-5 corporate job. I said something last week to my pediatrician daughter about "hanging out a shingle" and she had no idea what I was talking about. Doctors need to continue the old tradition of medicine.
    • MALGORZATABNOWAK
      I don't think the article really say we are lazy, however it is suggesting that we are not involved enough and allow third parties to take over medicine. I personally would go as far as saying that medicine has been hijacked by third parties for financial gains because of out lack of involvement. We just try to adjust to the changes.
    • Anonymous
      I couldn't agree more, especially on the topics of insurance, EHR, and Certification. And yes, being a Family Dr certified for more than 20 years I decided not to be recertified - this is really a scam and I do envy my internal medicine colleagues that have the courage to say - STOP! no More! EHR - no way. I prefer to spend time with my patients and reach the correct diagnosis instead of typing in a computer to, supposedly, improve medical care and reduce costs. When government officials know better than doctors how to handle health care? Shameful!!!!!
    • Doctors are not lazy, doctors are mandated do non medical things which are time consuming, non productive, nothing to do the patient care. In a traditional medical practice, only doctor and patient present, now we have HMOs, PPOs, PBMs Pharmacies, malpractice lawyers, big pharma, wall street listed profit driven insurance companies and hospital administrators advises the doctor and patient on health matters. What we learned in medical school we rarely practice in real world. Nothing is going to change, we have a bloated, least efficient and most expensive health care system. Insurance companies sell these high deductible policies which do not cover anything till you get extremely sick or admitted to hospital. Different medical societies give different guidelines on a same disease management like mammograms.
    • Anonymous
      You hit the nail right on the head--on multiple points. Doctors are required to do things & document things that are actually counterproductive to patient care. Putting extra, unnecessary information in the chart because of coding requirements detracts from solving medical problems. Unfortunately, computers have enabled medical coders to "capture" and bill for more non-informative medical information, thus forcing doctors to add non-informative, counterproductive documentation into charts. In medical residency we learned to that what to omit was just as important as what to include, because the former detracts from understanding the big picture and reduces focus on the information that realy IS important.
    • Anonymous
      If we want to change this trajectory, we need to reverse course completely by cutting regulations and mandates, implementing serious malpractice reform, and promoting free market principles on every level of the medical and insurance industry, (among a few other ideas,) and we will turn American physicians into the most energetic and motivated professionals in the country!
    • Dr. philip a. greenhill
      Dear Dr. Merrill, I could not agree more with your comments about those greedy insurance companies and the outrageous salaries of the insurance executives. The insurance system is set up so that it its difficult for them to loose. They sell policies with high deductibles that most people will not reach due in large part to limiting what physicians can balance bill. Them there are the high copays which will discourage many from seeking an office visit unless the problem is fairly severe. Either way the insurance companies win. We have a system in which the insurance companies get their huge profits and them leave physicians to "duke it out" to survive. This is absurd since we are the ones who have the goods and render treatment to our patients. I guess the health of insurance companies is more important than that of our patients and ourselves.
    • Anonymous
      I left my solo cardiology practice 9 months ago after 36 years. The article is correct but there is no solution. I now have an easy job with the enemy, the insurance industry. I never stopped examining patients and did my EHR documentation at night and on weekends. I had a huge practice, but the EHR consumed my life and all my free time. This is the final result of allowing the government and the insurance industry to mandate what we do. You cannot win at this unless you give up the notion of practicing honest and ethical medicine and find ways of milking the system by concentrating on making money by churning out unnecessary lucrative procedures and lab work. A small number of our colleagues are able to this a still get away with it. Otherwise, falling reimbursements require an ever increasing workload with the commensurate increase in computer documentation just to keep up with the increasing overhead and to make an modest and honest living living. It isn't worth it. 5 years ago, the president of the ACC stated that Congress was determined to put an end to the private practice of medicine. They are doing a good job of it. At least now, at age 68, I have my life back.
    • Anonymous
      There are solutions. If we want to change this trajectory, we need to reverse course completely by cutting regulations and mandates, implementing serious malpractice reform, and promoting free market principles on every level of the medical and insurance industry, (among a few other ideas,) and we will turn American physicians into the most energetic and motivated professionals in the country!
    • Anonymous
      Doctors aren't uniquely lazy. People, in general, are lazy. Considering the rapid changes in American Medicine, the author's expectations of physicians would be blasphemy if applied to any other field. Moderate financial motivations can only push people so far. Physicians are being crushed under the boot of government and insurance companies in a way that is completely unknown in medical history. The payment reductions, government regulations and mandates come down so fast and furious, there is no time to adapt adequately. In addition, the culture in Medicine as shift work has been promoted at every level of physician education and practice. Physician organizations who should be protecting physicians, like the AMA among many others, see their role more as promoting government intervention and socialized medicine, as well as "protecting the patient" - as opposed to simply representing what's desired by and best for the physicians under their purview. Doctors who want to excel financially need to hustle harder than ever before in American history. Some medical fields and positions are currently paid so little that they can not be filled by U.S. graduates. And, this all leads to the rate of burnout among physicians that is extremely high and getting higher. Yes, what seems like laziness to the senior, mature physician is in all likelihood a marked change in the culture of American Medicine, along with emotional and physical fatigue, and an appropriately jaded outlook of the future thrown in for good measure. The Laws of Economics apply to Medicine, as well. When you destroy the rules of supply and demand, sprinkle in some rationing, add some burdensome regulations, you by default promote the Principle of Least Effort and Path of Least Resistance. Lastly, if we want to change this trajectory, we need to reverse course completely by cutting regulations and mandates, implementing serious malpractice reform, and promoting free market principles on every level of the medical and insurance industry, (among a few other ideas,) and we will turn American physicians into the most energetic and motivated professionals in the country!
    • Anonymous
      Your solutions are never going to happen.
    • Anonymous
      So, what's your answer? Just call physicians "lazy"? There is so much we can do! You sound like a "lazy" naysayer. By the way, who are you voting for: Hillary Clinton or Bernie Sanders?
    • Unfortunately many are. They do not complete their charts at the end of the day. They do not do their refills and review reports sent to them. I have my work done at the end of the day. They must expect to be paid for nothing. I guess they want the Bernie Sanders entitlement.
    • Dr. Gilkison, nothing says "we don't care" as much as (recorded) "You've reached the office of Dr. I. Dont Care, MD, PC, LLC, Inc. If you have a medical emergency (or think you might have a medical emergency, or thought that if you called a medical office the staff might help you determine if you have a medical emergency), please hang up and call someone who might actually care. If you'd like to schedule a procedure, please press "1" for our mortgage department, because you'll have to take one out to afford it." In the old days it was "Doctor Caring's office, Nurse Jones speaking. How can we help you?"
    • Doctors aren't meeting care responsibilities --- "Doctors are lazy..." I totally resonate and agree with this author. The Profession of medicine has been sold out for the business of medicine. We sold out / gave up / or didn't even appropriately engage the surge from without...which took over our profession and burdened it with a yoke too heavy to bear without giving in. Meaningful Use...PCMH...Quality Measures...ICD-10...Pay for performance...EHR mandates or monetary penalties...making continuing in a private practice/or launching one nearly impossible. We largely have become "provider widgets" for a health care industry. Dr. Gilkison, your article is right on target.
    • Anonymous
      We Physicians didn't "sell out." Insurance companies, politicians, & our Corporate masters sold us out. Physicians didn't promote electronic medical records. Corporate Medicine did. Non-physician Corporate interests forced EMRs on us to increase Corporate Medicine's bottom line--not the bottom line of Physicians.
    • Anonymous
      Doctors who want to excel financially need to hustle harder than ever before in American history. Some medical fields and positions are currently paid so little that they can not be filled by U.S. graduates.
    • Anonymous
      You can call me lots of things; surly, tired, frustrated but LAZY doesn't fit.

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