My birthday tomorrow will be spent in service of my patients by day and training on a new super high-tech laser by night. Throughout my life I’ve made such choices that are not the most fun and most often are the last things I want to endure at the end of a busy day. I might grumble, “I’d rather be flogged!” as I forego the birthday dinner for the laser course, but, like most physicians, I have this inherent, unquenchable thirst to help patients, which requires we constantly improve, and give them our all, every last drop. Sadly, not a day goes by in clinic now that I am not fighting back tears, as my patients and I discuss the atrocity, insanity and reality of gargantuan federal healthcare law that is sucking the life out of the patient-physician relationship, the profession of medicine, and me. I am at a breaking point. The words demoralized, disheartened, and devastated are not strong enough. What will I choose to do about this?
I am not a quitter or an enabler, and I most certainly will not violate my code of ethics and betray my patients, as is required on October 1, 2015. This date is “Do or Die Day” for the federal government’s mandated use of ICD-10 codes to be able to bill government or private insurance companies for services to patients. Therefore, in a mere 9 days, I choose to practice completely 3rd party free. There is no other choice.
The response to my decision has been mixed. Those who value the patient–physician relationship, the Hippocratic oath, the great history of American medicine, individual freedom, patient choice, and personal responsibility support me. Bold physician leaders are forging new paths to practice medicine that retain physician autonomy and salvage patient privacy and dignity at a fraction of the cost by dealing directly with patients unconstrained by third party regulation, restriction and waste. Exemplary groups like the Association of American Physicians and Surgeons (AAPS) led by Dr. Jane Orient, Surgery Center of Oklahoma led by Dr. Keith Smith, Atlas MD led by Dr. Josh Umbehr, and a multitude of other pioneering entities provide incredible resources and serve as my models, inspiration and sources of courage to achieve this transition. The vast majority supports my move.
On the other hand, those who think the American people are stupid and incapable, those who seek single-payer socialized medicine, and those like Obamacare architect, Ezekiel Emanuel, who believes the Hippocratic Oath is outmoded, innovation too expensive, and that government must intervene with the patient-physician relationship, seek to castigate and denigrate those like me for daring to defy their top down diktats. I have been accused of “abandoning my patients for money”, which is a joke as my revenue will soon decrease when many of my patients leave me for different doctors who accept their insurance. The doctors who keep playing this game, implement, and comply with the central planners’ control of medicine the best will be the ones paid the most. I’ve been told that maybe I shouldn’t be practicing medicine at all, that I’m too old-school, because I won’t adopt the nonsensical, wasteful ICD-10 billing codes and government designed “meaningful-use” (classic use of Newspeak) electronic health records, which are interoperable with government and grant full access to patients’ medical data to be sold and shared with any entity the HHS Secretary deems appropriate. The charge that I shouldn’t practice medicine, because I’m an old school non-adopter is laughable as well; in fact, throughout my career I have been and continue to be an early adopter of the most innovative technological advances, as epitomized by spending tomorrow training on a new laser. My litmus test for “implement and comply” is twofold: 1. Does it serve the patient first? and 2. Is it the best use of resources? I invite these critics to my O.R., and I put our technology, facilities, professional staff, and outcomes up against any in the world. I then invite these critics to evaluate their relationships with 3rd party controlled, ICD-10 billing, “meaningful using”, data-collecting, in-network doctors du jour who must robotically follow government rubrics in order to be paid and publically scored for doing what the Secretary of HHS (a non-doctor) says.
Many of my patient-physician relationships span 2 decades of care and include 4 generations of family members. Many of these patients will stay in my care, I pray. But, the system is convoluted and confusing. Patients must be educated to understand what is going on. In many cases, it is more expensive to use health insurance than direct pay. My fees will be transparent and may cost less than most 3rd party fees. Most plans now have huge premiums, deductibles, and co-pays. For some patients for some services, my fees will be less than the copays. For most, even my surgical fees are far less than deductibles. Patients can deal with their private insurers depending on the particular “out of network” benefits of their plans. Physicians must educate patients, who have been subjected to 3rd party propaganda and marketing ploys, about the real costs and restrictions of 3rd party control of their healthcare. Communication is key.
Clearly, coverage is not care. As patients, we have spent our lives paying into Medicare and are now mandated to buy government-prescribed health insurance that is proving to be not affordable, not individualized, not easily accessible, and not best quality care. Many patients feel cheated, lied to, and angry. One reaction is to blame this on the doctors. We are on the front line of patient contact. We have been lied about and vilified by President Obama from day one. We are there face to face with patients when insurance companies hike rates, delay and deny care, and frankly mess up. We are there when patients are sick, scared, frustrated, and fed up. Consequently, more patients are filing more complaints and false allegations about physicians with state medical boards and consumer protection agencies when, in fact, the physician was trying to help the patient and was not the root of the problem. We are there for the flogging- left to defend ourselves, guilty until proven innocent, or else. This is when you really just want to throw in the towel and walk away.
As October 1st approaches, my heart flutters somewhere between exhilaration at the prospect of the ability to once again freely practice the patient-centered medicine of Hippocrates out from under the 3rd party boot, trepidation at the prospect of going completely out of business at what should be the pinnacle of my career, and a heart-stopping sorrow at the reality of losing so many of the precious, sacred relationships with patients that have been cultivated over the past 20 years. That hurts the most. The patients may leave me; I’m not leaving them. Patients and doctors must get educated, educate one another, and stand by one another if we are to survive all this. I hope my own oncologist, physicians, and surgeons don’t throw in the towel. They know me. We have something together that has value. I need them. I will happily pay them a fair, transparent fee. They’re worth it.
As I seek strength and wisdom through this, I am drawn to the apostle Luke, because he was a physician. Luke wrote the Book of Acts, which speaks to me about physical healing, spiritual healing, and salvation. It speaks about serving others through the presence of the Holy Spirit. Acts Chapter 4 and 5 are shouting at me.
Acts 4:8,9 “Rulers and elders of our people, are we being questioned today because we’ve done a good deed for a crippled man?”
Acts 4:13 The members of the council were amazed when they saw the boldness of Peter and John, for they could see that they were ordinary men with no special training…”
Acts 4:19 But Peter and John replied, “Do you think God wants us to obey you rather than him?”
Acts 4:21 The Council then threatened them further, but they finally let them go because they didn’t know how to punish them without starting a riot. For everyone was praising God for this miraculous sign- the healing of a man who had been lame for over forty years.”
Acts 4:29 “”And now, O Lord, hear their threats and give us, your servants, great boldness in preaching your word.”
4:30 “Stretch out your hand with healing power; may miraculous signs and wonders be done through the name of your holy servant Jesus.”
4:31 … Then they preached the word of God with boldness.
4:32 All the believers were united in heart and mind.”…
Acts 5:29 …Peter and the apostles replied, “We must obey God rather than any human authority.”
Acts 5:40 “…They called in the apostles and had them flogged.”
5:41 The apostles left the high council rejoicing that God had counted them worthy to suffer disgrace for the name of Jesus.”
I pray for the continued blessing of the freedom and ability to do good deeds for others, to serve them, and heal them. Help me be bold and obey you, even though I may be threatened and spiritually flogged. Thank you that I am worthy to suffer. I pray patients will see the truth and choose to stay with their physicians in meaningful long-term relationships that are focused on doing what is best for the patient with privacy, dignity, compassion, and mutual trust. As a people, may the Holy Spirit abide in our presence giving us strength to obey you, act boldly, and unite in heart and mind. Amen