Going through the economic and emotional acrobatics of buying a car is not the highlight of my world. However, it is one of those necessary “evils “ that is just part of life. But here’s the rest of the story.
After I made multiple trips to the showroom in sub-zero temperatures, the salesperson and I finally reached a point of détente—a measured equilibrium where we each felt vaguely satisfied to seal a deal and move on.
The final gig in this drama was my being escorted to see the manager for some last-minute paperwork, all part of the ballet that is car buying in person.
The manager explained that customer satisfaction and service was the dealership’s number-one priority. And then came the question: “Well, how did we do? Would you rate us ten out of ten?”
I said absolutely “no" and launched into a litany of reasons why I was hardly a happy camper. Phone calls were not returned. There was always some last-minute invoice of some expense that I did not expect. Accessories that were viewed as standard were now on the bill.
The manager was taken off guard and then apologetically said, “Well, Louie has not been bringing his A-game to the table every day. I do not know the details but he has been struggling with some stuff at home, throw in some poor financial decisions, and he is in some other orbit. We have talked to him and this will get cleared up.”
Let’s just say I felt victimized, marginalized, not the focus or priority of this dealership where the personal issues of one of their salespeople became my problem, and it should not have been.
What does buying a car have to do with your doctor?
Like the car salesperson, your healthcare provider, regardless of initials and credentials after their name, is expected to bring their A-game to the workplace every day. It goes with the territory, it goes with the training, it goes with a history of the profession. Every day is Game 7 of the World Series, there is no mulligan, there is no do-over, there is no dress rehearsal, especially in a surgical or technical specialty where a loss of focus could have catastrophic implications.
So what does this have to do with you and me? Well, it has a lot to do with us.
We now know that medicine has reached the tipping point. And here are some numbers.
Is your doctor burned out? Depending upon the source, 50 to 60 percent of physicians fulfill the criteria for burnout: emotional exhaustion, lack of empathy or negative attitudes toward patients, and a feeling of decreased personal achievement.
Is your doctor at risk of suicide? Approximately 400 physicians, about one a day, take their own lives at a rate that is especially ominous for female healthcare professionals.
Will these doctors in training ever practice medicine? At least 25 percent, at a minimum, of medical school graduates will not practice medicine but instead will head toward administrative, leadership, commercial, or research environments. Medical students and residents model the behavior of their mentors. When they see the pressures and the demands of a clinical practice, many are shifting their focus to nonclinical arenas. Approximately 75 percent of medical schools now offer a dual degree imbedded into the medical school curriculum involving law, an MBA, or master’s in healthcare administration. And students who have those degrees rarely have a full-time clinical practice or never see patients.
Is the electronic medical record to blame? EPIC is the most widely used electronic health record instituted in every medical office and hospital. It’s high tech. It requires an additional 25 hours a month from the providers to enter information into the health record. What was thought to be an efficient replacement for paper medical files has become an albatross around the necks of healthcare providers. In some primary care clinics, more time is spent per patient typing into the record and reviewing the electronic record than in face-to-face contact with the patient. In one study during an emergency room shift, a provider would make 4,000 clicks a shift and many of these have no bearing whatsoever on care. But are required for our regulatory compliance.
Is COVID to blame? Yes, COVID is to blame for a lot of changes in healthcare delivery. Pharmacists are now giving shots to more people than ever. Long-term effects of COVID are still unknown. Healthcare providers worked during the worst of the worst at risk to their own health.
Do doctors care about customer service? The burned-out provider has a higher frequency of dissatisfied patients, malpractice claims, and, in limited studies, has been associated with more surgical complications. Yes, they care, but factors are causing them to flame out.
So what this is really mean to you and me when we seek care?
We need to recognize and understand that the practice of medicine is almost unrecognizable compared to that of just five years ago. Patients in general are older and sicker, have more complex medical demands, and the provider is squeezed by administrative and economic imperatives to make the exam-room time faster/quicker, to see more patients. This means we need to be attentive and vigilant about the provider of our care, which could have life-and-death consequences. And here are just some examples.
A middle-aged woman had far advanced colon cancer and had cascaded through a number of chemotherapy regimens. She sought care at a prominent national medical facility as a last resort. The anxiety was palpable for her and her partner. The provider did not knock on the exam room door. She brusquely opened the door and clearly appeared to be hassled, frazzled, and pressured for time. There was a very terse introduction, a rudimentary review with the patient of her care, and when the patient respectfully inquired about prognosis, the patient was coldly told, “I do not think you’ll make it a year.” What happened to compassion?
A gentleman in his fifties had been a competitive cyclist. This was his identity. During a fall two years earlier, his right foot became entangled in the stirrup of his bike, and during the fall, he ruptured multiple tendons in his foot. After rudimentary treatments of ice and elevation his pain reached a crescendo of 10/10, so emergency surgery was done followed by complex aggressive physical therapy. Two years later, the patient was profoundly incapacitated and during brief visits with the operating surgeon, the patient was faced with a dismissive attitude. According to the patient, before the surgeon was fully in the exam room, his hand was already on the door knob to leave.
A fit athletic woman in her seventies was an active golfer and runner and pickleball player. She developed pain in the tibia, which is the long weight-bearing bone in the leg. She visited one of the top orthopedic groups in her community and was told on the basis of an MRI scan that there was “inflammation” in the bone. Specifically no mention of osteoporosis, osteopenia, or a fracture. The patient was appropriately advised to use the non-weight-bearing boot as well as crutches. After six weeks the patient was told that she could symbolically discard these devices and she would be fine. Upon recurrence of the pain, a follow-up MRI showed an obvious fracture of the bone the doctor had missed. And the patient was blamed that this is what she should expect because she was thin, she had fair skin and blue eyes putting her at risk for osteoporosis so this was totally unavoidable. She was told to “just deal with it.”
A male patient was told the doctor’s office would schedule an MRI to view his optic nerve behind his eye because there was some unexplained inflammation. The doctor’s office never called with the schedule. The patient emailed the doctor on the patient portal because a follow-up visit was coming up. Overworked, hassled office staff had failed to properly follow up and a patient visit was wasted without the results of the scan.
Insert your own story of an abrupt doctor visit, a missing test, something not scheduled, a mistake. We all have them. And most of the time the reason is that healthcare providers are burning out, burning candles at both ends, feeling pressure to see more patients faster, and not being able to catch up.
All the more reason for you to become that empowered patient we all need to be when it comes to our own medical and that of our loved ones.
When we seek care, we also need to be street smart and savvy about the demeanor of the provider. You don't have to have a PhD in psychology to notice some characteristics indicating burnout.
Beware if your provider does this:
Pressured speech. Runs late. Doesn’t seem to be listening to you. Won’t address your list of problems. Answers with just a few words.
Seems distracted or preoccupied with paperwork in their hand. Not yours. Is interrupted by staff knocking on the exam room door. Leaves to take a page or call.
Seems to be in a hurry. Doesn’t sit down. Stands by the door with a hand on the doorknob.
Doesn’t seem to know your case. Doesn't note anything in your medical record.
Now what? Say this.
If faced with a provider who just isn’t on the same page with you, for any reason, you can reasonably say this:
Doctor, you don’t seem to be listening to me. Should we reschedule another appointment? Maybe you are too busy today.
Or
Doctor, I’m just not feeling that you understand my health issues. Should we seek another opinion?
Or
Is there another doctor in this practice or elsewhere who is more knowledgeable about this condition that I should see?
Or
You seem distracted today. Too busy. When might we talk about my condition when you are better able to focus on me?
Or
You simply see another physician for your condition in a different office. Seek another opinion. Ask the medical practice or hospital administration for referrals after expressing your concerns.
If your healthcare provider is just not there for you, seek care elsewhere. No one has a greater stake in your health than you do. Besides, in this pressured healthcare environment, you want the keys to the kingdom, access to all the features, not just the stripped down bargain model that's been sitting on the used car lot for months. Right? You're in the driver's seat.
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