When I first started my career in medicine, CT scans and MRIs were nonexistent. Scientific advancements and technology facilitated the development of these and many other diagnostic tools.
These changes have enhanced medical care, enabling physicians to diagnose and treat patients more effectively. The integration of computers has played a crucial role in this advancement by ensuring better continuity of care, whether at home or in the hospital, through improved communication between doctors and patients.
Simultaneously, driven by profit motives, businesses, including insurance companies and hospital administrators, have taken much of the medical decision-making away from doctors.
I have been in private practice nearly four decades, which means I am a small business owner with independence in decision-making.
In the past, private practice doctors cared for patients in their offices and made hospital rounds during non-office hours. This sometimes involved attending to hospitalized patients early in the morning, in the evening, or on weekends, but it was manageable.
I trained as an internist, initially in a hospital and later transitioning to my private practice after residency. Typically, I would see patients first in an office setting, getting to know them and their family members while treating them in a nonemergency situation. When they became ill and required hospitalization, I would act as their admitting doctor, overseeing the management of their care.
During my residency training and experience, I learned when it was safe to discharge patients home. I also recognized the importance of maintaining continuity of care in the transition from hospital to home to prevent readmission.
Most importantly, I got to know my patients personally by asking about their backgrounds, including where they grew up, their family life, education, jobs, children, military service, and concerns. This eventually led to a transition into end-of-life decisions. This is the humanity I brought to practicing medicine.
However, hospitals and insurance companies viewed it as economically inefficient for private practitioners to care for hospitalized patients. Balancing hospitalized and office patients was part of my training, and most internists and family practitioners are adept at it. Despite this, with financial interests backing them, the hospitalist was born.
What has been lost is the continuity of care. Even with technology, office doctors assessing recently discharged patients have a limited ability to understand the full scope of hospitalization. Most of the time, when asked, patients and family members are unaware of what the admitting diagnosis was, let alone what care is necessary to prevent readmission for the patient.
Hospitalists are capable, board-certified practitioners; however, many are young and lack experience. The most disconcerting aspect of this situation is that they are either employed by the hospital or contracted through affiliated physician groups. This arrangement may lead to economic manipulation of their contracts, affecting medical decision-making. How many hospitalists bear the burden of medical school debt, a mortgage, and a family to support? Can we blame them for hesitating to express their true opinions, risking their contracts?
Data collection is ubiquitous in society and is used to measure efficiency. Many hospitalists face statistical constraints when measuring utilization, which includes patient length of stay, lab tests, radiologic images ordered, and requests for specialty consultations. These factors can incur costs and reduce profits, leading to pressure on contracted doctors who are not in private practice to minimize the amount of care they provide. This, of course, could be at the expense of your health.
Hospitalists often lack familiarity with their patients’ backgrounds and know them only superficially. This results from being taught that such information is “insignificant” and not essential for providing medical care, leading patients to feel as if they are on a conveyor belt.
In private practice, hospital administrators cannot dictate my medical decisions. Although it is illegal in California for a hospital to practice medicine, they have circumvented this law by using business tactics of coercion.
Some of my colleagues have now accepted their roles, remaining only in their office practice despite their training, while others in private practice continue to see patients both in the hospital and in the office. Technology has allowed them to care for hospitalized patients through computer contact via hospital portals, providing real-time care. Additionally, communication from hospital nurses enables rapid medical decisions, ensuring quality care.
However, private practice physicians are rapidly being driven out of the hospital environment by administrators skilled at creating contracts that compel doctors to adhere to the bottom line.
Ironically, the data collection that hospitals now employ against doctors reveals the dire health care conditions Americans face due to administrators’ poor decision-making.
The use of CT scans, MRIs, and computers has greatly benefited physicians in enhancing patient care. However, the business takeover of medical decision-making, the loss of continuity of care, and the increasing number of contracted physicians susceptible to coercion are harmful to our nation’s health and well-being.
Humanity must be prioritized over profit.
Gene Uzawa Dorio is an internal medicine physician who blogs at SCV Physician Report.
