Obama’s Speech: What’s an internist to do?

I’ve been watching the healthcare reform debate from a distance, like all doctors. It was a brilliant stroke of genius on the part of both Republicans and Democrats (when they undertook the job of changing all of healthcare) to do so without the input of any practicing physicians. I’m very glad about this – it makes the discussion so much more “out of the box” and “process oriented” and only rarely causes “patient death.”

Besides, I’m waiting for my chance to participate when we overhaul the legal system and exclude all the lawyers. Or maybe I’ll hold out for the Plumbing Reformation Act – I’ve got some deep insights (so to speak) on the whole butt-crack issue.

It’s not like any of it really affects me, anyway. See, I’m a breed of physician that’s an endangered species – I’m an internist. My days were numbered before any of this began. Literally. It’s like the twelve days of Christmas. Seven minute visits, 12 reviews of symptoms, five vital signs, four billing codes and one Pap smear & phlebotomy – there’s no part of my daily job that doesn’t require a number. Well, except for talking to patients. But (shhh) I’m not actually supposed to do that.

The whole talking, examining, pondering diagnoses, using the old brain, laughing with patients thing – I admit it, it’s frankly a problem for me. Kind of like an addiction. I just can’t seem to stop. I know I’m not supposed to do it, it’s not “reimbursable,” it doesn’t fit with any billing codes (and therefore can be interpreted by somewhat zealous reviewers as a form of Medicare fraud), and, frankly, it makes people nervous. Last time someone threw out the idea that I might actually get (gasp) paid to do it, I got accused of gerontoslaughter (latin: knocking off old people; see death panel: Palin, Gingrich, et al.). No one wants us practicing docs to indulge in something that’s obviously dangerous, addictive, and possibly subversive. I’ve heard, from back in the old days, that it’s like imprinting newly hatched geese. Once you bond with a patient, who knows what could happen? There you are, sauntering across the street, and one of them tries to talk to you. Who wants that kind of responsibility?

Much better to stick to the evidence-based (not profit-driven, oh nooo) steps of our more modern approach:

1) Patient checks in, gets twelve page questionnaire detailing everything that we, as doctors, don’t have time to ask (Question 187: “Does your left anal 2 o’clock crease hurt?” Check one or more: “yes, no, the French revolution, 32 kilo-ounces, or only during family holidays;” Question 213: “How often do you sneeze per month?” Answer options: “yes, no”).

2) Patient sent stampeding down narrowing hallway chute, in order to be (by nursing staff) captured, stripped, hog-tied and left trussed on butcher paper.

3) Door bangs open. Before it can hit the opposite wall and rebound to swing closed again, I must complete the visit. “Sore throat?” I bark. Patient: frightened nod. Heading off any potential discussion, I whip out a penlight and blind the person as I yank open the jaw (insider tip: people are much more compliant when all they can see is amorphous blue blobs). Behind me I am aware that the door has connected with the wall and has started its return. Oh God, hurry! I rush to the computer and order a strep test, a blood count and a follow-up visit while simultaneously prescribing penicillin, cross-checking for allergies, updating the problem list and downloading a new episode of Gossip Girl.

4) Patient (rubbing jaw) opens mouth to say something but I see the door swinging back, closing, the gap shrinking, smaller, smaller. I assume the Usain Bolt starting block position, look up over my left shoulder and chant my profession’s new motto “You’ll need to make another appointment for that.”

5) Will I make it? I hear pleas and begging behind me, I feel the tug of my past medical school hopes and dreams and naivete’ weighing me down, but nooo, I won’t listen! I break free, prodded like an electric cattle shock by the memory of prior failed productivity ratings and before the door closes I slither through the shrinking space, I’m out, I’m free, catapulting like a guided missile breaking loose from the pull of gravity, of disease, of discussion I rocket into another room, this new door banging open in front of me, heading for the wall, the strobed image of trussed patient eyes pleading wordlessly again…

6) But wait. I forgot. I must document. Instead of opening the next door I veer past that exam room. I wait five minutes to log on and clear the security measures (gack, those DNA microbiopsies sting like a mother) to access my mandatory EMR workstation. While I wait for my security-DNA-biopsy (patent #1R45B87, SecuriCorp, Defense Contractor To The Stars) bleeding to stop so I can type, I am aware of the nursing staff behind me prodding the “sore throat” patient down the exit chute. Don’t make eye contact. Finally cleared to use the system, I write a 287-page, 13 chapter memoir about “sore throat,” with appendices, original source material, two diagrams, a pie chart, surveillance photographs and a YouTube video presentation, all of which is required for (possible) insurance reimbursement. THEN I go see the next one…

So you see, this whole healthcare reform thing doesn’t really affect me. Any more than it does you. Sure, I’ve heard tall tales from the rocking-on-a-porch old-timers, those myths about the prehistoric days when dinosaur doctors ruled the

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earth – when you could throw your primary care massive weight around and decide for yourself how to treat a patient, who you would see and how long to spend. Hell, I even heard there are Jurassic-Park-like pockets where such a thing still exists. Exotic, tribal locales with primitive, rudimentary, non-capitalistic approaches to healthcare. Places like London and Paris and Stockholm. Shudder. Thank God we don’t have to live in fear like those people must.

After Obama’s speech last night, I’m seeing the writing on the wall. There’s only one thing for me to do. Get another job. Quick, before the mass exodus. I sure don’t want to get caught in the nationwide stampeding horde of six remaining internists. But I’m not sure what I might qualify for, so I’m hoping to get some reader feedback. [Keep in mind, I’m trying here to keep my resume’ focused off the dying field of medicine (which tends to lie like a rotting cadaver on the page) and focused instead on my people skills. Ready?]

Resume:

Post-grad: Harvard Medical School, magna cum laude. Area of study: um, NOT primary care. No way. There’s not even a primary care department there any more. Really. I swear.

Residency: UCSF straight internal medicine program. While “straight” may be accurate in this case, it is not necessarily a reflection of sexual orientation. Given the right pay scale, I can be adaptable.

Fellowship: of the rings.

Honors/awards/achievements:

Voted “Most Likely To Love Mucosa,” Class of ’91

Speedwalking Champion, Moffit-Long Annual ICU Gala

Acquired skills:

Long index finger, highly diagnostic. Short nails.

Lady MacBeth handwashing-obsessed. But in a good way.

Can hit an artery with a 23-gauge micro-spear at twenty paces.

Using active, take-charge verbs, my future plans include:

I will secure (acquire, master, assault, take down like a one-person pack of rabid hyenas, in fact totally own as my b#%@ch) a fast-track, career position in a burgeoning field wherein I will never, ever (not even during performance appraisals) be required to use the words splenic infarct.

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