As a family physician for 18 years, I really related to Dr. Hickner’s editorial, “Have family physicians abandoned acute care?” (J Fam Pract. 2013;62:333). I ran a solo practice for the past 10 years, and my staff and I were able to offer sameday visits to most people who needed acute care.
I recently sold my practice to a federally qualified health center (FQHC) to become an office in that system. The FQHC receives federal and state funding as well as grants, which make it possible to see patients regardless of their ability to pay. However, each entity has its own agenda.
The result is that a host of issues and scripted questions are inserted into the exam room. The questions may be medically justifiable, but given the time pressures of a typical visit, my ability to prioritize based on patients’ individual needs is hampered. If you actually asked all the recommended questions, you would use up most of the time allotted for the visit without ever hearing the patient’s 3 or 4 complaints—which usually hold the key to the real health issues.
The data we are required to submit in order to continue receiving support nearly always track process measures. No one measures whether you made the right diagnosis or whether the patient got better—a point the media have remained stunningly ignorant of.
Jay A. Zaslow, MD, MPH
Brewster, NY
I absolutely agree with Dr. Hickner that we are now practicing medicine to be evaluated, not to treat patients. We are being judged the way teachers are with No Child Left Behind. We spend so much of our time on our agenda that we miss what medicine is really about.
I work at a large health care system, seeing patients in preventative medicine/ I'm also in charge of teaching medical students physical examination and history. I have tried to keep the focus on patients' chief complaints and immediate needs, as Dr. Hickner advocates, but the students do not see that approach when they go to their preceptors' offices.
What a pity. We need to preserve what the practice of medicine is all about, not just meet the numbers.
Mary Marcinko, MD
Riverside, Calif.