By Dr. Tim Hanlon

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As a physician who has practiced in the state of Oregon for 35 years, I am writing to hopefully shed some light on why physicians now spend less time with their patients. When I entered medical practice in Bend in 1980, I had been trained and educated in the profession of medicine. Patients were placed first and their well-being was paramount. Medicine was practiced with high ethical and moral standards. Physicians and patients collaborated to deliver the most appropriate management plan.

This is the professional model that no longer exists. So, what has happened?

Perhaps the most devastating development has been the application of the business model to health care. A variety of factors led to this trend. Increasing health care costs, more stringent federal regulations and insurance company mandates all impinged on the physician’s capacity to remain at the helm of medical management. Doctors were forced to leave their independent practices and join larger groups, which employed business administrators. Nonetheless, at this juncture, physicians could still freely make appropriate patient-directed ethical choices for their patients, largely unencumbered by today’s restraints and controls. Doctors were able to spend the necessary face-to-face time with patients and explain their thoughts and plans of action to those entrusted to their care.

Over time, government regulations and insurance requirements grew exponentially. The corporate model eventually replaced the business model. By their very nature, corporations focus entirely on the bottom line with little room for the primary goal of patient-centered management. Health care entered a new realm, and physicians were no longer professionals, who, in conjunction with their patients, made the best decisions possible. Even the time spent with each encounter was dictated by the corporate body. Administrators flourished, for whom high salaries became the norm, and soon they became an increasingly large portion of the medical workforce. Whereas the original pyramid of health care placed patients and physicians at the top, almost overnight the pyramid was inverted, and physicians and their patients were replaced by administrators at the pyramid top.

To add insult to injury, the advent of the electronic health record ascended to primacy. The computer now occupied a position interposed between the doctor and patient, both literally and figuratively. Physicians spent more time looking at their computers than their patients. Doctors became data entry technicians at the cost of time for their patients. Alas, the electronic health record was designed for revenue capture rather than patient care and has in many circumstances actually impaired the quality of medical care, as well as patient and physician satisfaction.

The costs of mandated electronic records, insurance regulations and pre-authorizations fueled a migration of physicians from “private practice” to employment models controlled by the corporate behemoths of health care such as St. Charles Health System locally. Doctors were now controlled by government, insurance companies and their health systems’ bosses. Face-to-face time with patients was dramatically reduced to increase revenue capture and increase doctor “productivity.” Caring for patients as the primary focus finally had been crushed by the bureaucracy. Now administrators, with no knowledge of direct, hands-on patient care, largely controlled this previously professional and sacred portion of health care. The “bottom line” defined by administrative accountants now ruled the roost, and unfortunately both patients and doctors have lost in the bargain.

So, what is to be done? Physicians must step up and speak out for their patients, insisting on a return of the primacy of the doctor-patient relationship. The road back is long and will be slow. By joining hands, doctors and patients, together with our nursing partners, may yet win back the necessary realignment of health care to the thoughtful and compassionate care of patients.

This is written hopefully to start this process locally. I urge each of us, doctors, patients, nurses, and the entire community to speak up. To be silent is no longer an option.

— Tim Hanlon is a doctor in Bend.

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