OK, I am going to vent a little. Here I am in this large, respectable medical entity, clicking away in an effort to be a good employee. The software will not allow me to add health maintenance items such as bone density scans. I cannot add hepatitis immunization for patients with liver issues or otherwise. I cannot put in ASA, statins, ACEI as meaningful things to do to my diabetic populations. In my mind they are struggling to meet MU2 and, at this rate, IMO will never make it to MU3 although that is where I will be, and God help them when ICD-10 comes rolling in. BUT!!!!!!! They pride themselves in the fact that their EMR is meeting all the meaningless use criteria. And, for the most part, their physicians are practicing way below where they should be.
I saw a 41 year old diabetic today....diabetic for over 10 years and already S/P CABG....who is followed by an endocrinologist here. He was dumbfounded when my nurse asked him to take off his shoes and socks...no one had ever checked his feet before. He has never had a dilated eye exam and never been urged to do so. His LDL is 150 and he is not on maximun-dose statins. A previous CT of the abdomen done for some other reason clearly shows fatty liver but he has never had either his Pneumovax or Hepatitis immunizations. He has never had even a random urine for microalbumin not to mention a 24 hour one. He told me the endocrinologist simply downloads his meter, tells him to lose weight and to come back in 6 months.
Now I wish I could say this was an isolated observation but it is not. I cannot help but wonder how much the time and effort required to document meaningful medicine has done just the opposite and made it meaningless, not to mention dangerous. I am convinced there is not a shortage of primary care physicians....they are all just too busy clicking to take care of their patients.
I had a really hard time admitting to myself that I could no longer sustain my private practice. I felt like a total failure, a business idiot, a maverick running from the drovers into the thicket of thorns. But I now see the only thing I failed at was knowing how to play the game now put before me. Sad thing, though, now that I understand the rules, I am not sure I want to play any more. The endo guy is pulling in a bunch of money, the employer is happy and the MU clicks are being clicked and the epidemiologists have justified their existence. And, like the proverbial lemming we are all standing looking over the cliff. Heaven help us. Hang in there guys!
