Perhaps as never before, the medical establishment is transforming, facing both challenges and benefits. Case in point: electronic medical records. These hold the promise of being able to track health conditions more effectively, but at what cost to the patient-physician relationship if the doctor spends the visit typing on a keyboard?
The American College of Physicians, the national organization of internists, has been on the front lines of issues from EMRs to climate change, gun violence, insurance and the cost of prescription drugs.
Its newly named executive vice president and CEO as of this September is Darilyn Moyer, a Temple University professor of medicine who holds several leadership positions at the Lewis Katz School of Medicine.
She spoke to us recently about a few key issues facing internists and their patients.
What can you tell us about the high cost of prescription drugs?
This is an issue that is alarming everyone, regardless of political leanings. Patients are unable to afford medication, particularly for some of the newer therapies - the cancer drugs, the hepatitis C drugs. We're seeing an escalation in prices of drugs that have been on the market for a long time.
This is a vital issue that is affecting our patients every day. And it's affecting the primacy of the physician-patient relationship. We want to get back to having more face time with our patients rather than spending time on the phone with the insurance companies, with the pharmacy benefit managers. Patients are being asked to pay a lot of out-of-pocket costs. There is a complicated system of patient vouchers and co-payments. If we were able to negotiate more reasonable drug prices from the get-go, there wouldn't be more of these hoops for patients and offices to go through to get the medications that patients need.
Why is climate change a major concern of the ACP?
There's absolutely incontrovertible evidence that we are seeing significant health effects of global climate change. Zika is the one we have been hearing about more recently, but we have been seeing exploding epidemics of dengue and chikungunya, also spread by mosquitoes. And malaria has plagued us for many, many decades. We're also seeing the migration of mosquitoes, due in part to warming temperatures and humidity changes. We humans have a part in this, and we need to look at this as truly an ethical and a public health issue.
This risk now of going to the Caribbean for a vacation and worrying about whether you are pregnant, or could you potentially become pregnant - you now need to think about where you are going to travel. This has huge implications, not just for the health of Americans, but for the health of everyone in the world as we see climate change unfold.
Electronic medical records and administrative hassles seem to be high on everyone's list of problems.
I was at a medical conference recently, and one of the keynote speakers showed a video. It was of a boy, 7 or 8 years old, sitting on a sofa, staring at a computer screen, clicking on a keyboard, not breaking his vision at all. Peering around the corner were his parents, who were just beaming. One of them said to the other, "Oh look, he wants to be a doctor."
There are wonderful benefits of having electronic health records. However, we really want to get more usable health information technology systems. Less clicking. A recent study found that in a 12-hour shift in an emergency room, a physician in training had to make a click several thousand times.
That's resulting, quite frankly, in an epidemic of professional dissatisfaction in the medical community. We want doctors to be satisfied because that results in better care for their patients. Happier doctors who are professionally satisfied are more engaged.
According to another statistic, physicians spent 43 minutes per day interacting with health plans. About 74 percent of the administrative burden in a medical office is associated with all that time spent preparing paperwork. We have an initiative called Patients Before Paperwork. We're trying to reinvigorate the patient-physician relationship by challenging unnecessary practice burdens.
"High-value care" is another focus of the ACP. What can patients do themselves to get better care?
Patients need to get informed. There are a variety of resources available to them. For example, we have a new partnership with Consumer Reports. One result of that is an area of our website, written in conjunction with Consumer Reports, with information on various topics patients might need to learn about. One is about how to seek health care. It defines the difference among the primary care practice, the retail clinic, the urgent care clinic, the emergency room. It talks about where to get care for different care scenarios, and it talks about cost. (Click on the "clinical information" tab, then click on "high value care.")
Also on the website is specific information about health choices, high blood pressure, cholesterol, maintaining a healthy weight, limiting alcohol, not smoking. We are urging patients to empower themselves and learn about their health.
It sounds a little as if we're getting back to basics.
We cannot interfere with or supplant the important patient-physician connection, that important face-to-face time. That physical laying of hands onto the patient, that important bond, has been the primacy of medical care for thousands of years.
Regardless of how much medicine changes, at the end of the day it's about a singular relationship between the patient and the physician. We can't allow it to be lost in the transition. That's what the message of the college is. That's what the message of everyone in medicine is.