The Democratic response to President Donald Trump’s speech to Congress by our former governor of Kentucky does not represent an accurate perspective of medicine from the standpoint of a practicing internist.
As a physician practicing in Kentucky over the last 15 years, I have experienced a lot of change, most of which unfortunately has occurred in the last five years. The push by the federal government to use the Electronic Health Record through the carrot of Meaningful Use requires physicians to tote around a computer from room to room.
Instead of looking patients in the eye during the encounter, I am focused on pressing an icon about whether a patient has had a fall in the last year or asking about throw rugs in the house. A consequence of becoming a data-entry operator is that I see about 15 percent fewer patients a day than when I wrote in a paper chart.
Another unintended consequence is that over 25 primary-care physicians in the Louisville market have transitioned their practices into a concierge- or retainer-type practice. I am in the process of losing two partners to this. As we recruit to fill their positions as general outpatient internists, I am finding that it is like locating a unicorn; they don’t exist.
Physicians completing internal medicine residencies are either becoming hospitalists or specialists. We are beginning to experience a shortage of primary-care doctors.
The cost of generic medications has been gaining notoriety in the media. Recently I saw a patient in follow up whom I had seen in January for hemorrhoids. I asked how he was doing and the gentleman told me that the prescription was $1,000. The pharmacy was able to locate a generic form for $250 but the patient had to drive one hour to obtain it.
That is a lot of money for a suppository.
When patients express their concerns about the cost of medications I am sympathetic, but I also let them know we do not want the government to step in and limit the price of a medication. If the government limits the price then there is nothing stopping the government from limiting what you or I earn.
The solution to driving down costs is to increase competition and limit regulations.
As the Wall Street Journal discussed several months ago, the government is regulating how many medications can be made on assembly lines. I don’t remember any patient telling me that they went to pick up Viagra and got hemorrhoid cream instead as a result of a lack of quality control at a factory.
“If you like your doctor, then you can keep your doctor” is a also a farce. I had a blue-collar patient over one year ago change doctors because he got into a state plan and I was not on it. I hated to see him change doctors as I had taken care of him for years and he had become like family.
Not only has government health care limited the number of patients I can see per day, it has dictated who can see me.
Lastly, I seldom meet a patient who is happy with the cost structure of their insurance. Many have experienced increases in premiums and now have deductibles as high as $7,000. If you are truly a middle-income American making a median household income of $56,516 based upon 2015 data, a $7,000 deductible can contribute to a difficult financial situation.
I make myself quit typing and look patients in the eye and remind myself that patients are not spreadsheets but individuals who have loved ones counting on me to get it right the first time. I remind myself that I am not currently going to transition to a concierge practice as I have 1,400 patients counting on me to make their lives better.
I try to calm myself down when I get the prior-authorization form from the pharmacy, realizing that it is important to get the medicine covered at an affordable price so patients can get their meds.
I hope that Trump fulfills his campaign promise and that Congress works with him to change our health-care system to make medicine great again. I am frustrated, weary but determined to persevere.
Timothy A. Bratton is a physician in Louisville.