Whining is complaining without offering any solutions. It tends to be overly emotional, not thoughtful, and not very helpful. Whining is frequently discarded as useless and those who whine regularly are often viewed as “part of the problem.” But what if the solution is too complex to understand or it is too overwhelming to implement? At that point, is it whining to point out obvious failures without offering tangible solutions? Such is the dilemma in medicine. So much to complain about and so few good solutions.
More and more of my day is taken up doing uncompensated and truly useless work. Just today I had to write a new prescription for lab work as the old one was written 3 ½ months ago (in the ICD-9 world), and I had to fill out a prescription refill for diabetic test strips three different times because the first time it did not specify how many strips the patient would be using/day and the second time it did not specify the ICD-10 code (my emr’s fault). Other days, I have to do prior authorizations for radiology (ultrasound, CT or MRI), pharmaceuticals (now even for the older, generic medications), and school notes, work notes/restrictions, etc, etc. None of these are difficult or time consuming in and of themselves, but together, they take up significant amounts of time and become the collective straw breaking my back. They are also totally useless—Why is a parent’s note not good enough for school? Why can’t the employer/school just look at the prescription bottle to verify its usage? And what the hell is the reason for needing codes to justify diabetics trying to keep their blood sugar in check?
Many of my colleagues are charging a non-covered benefits fee for doing this work. I totally understand their reasoning, but find I am hesitant to do the same. The patients are not the ones who invented the forms and paperwork, and in many ways, they too are victims riding in the same paperwork boat as us. To charge them extra money seems misplaced. Instead, I would love a new administrative code which pays around $30 for every 5 minutes of admin time. I promise to use new code with reckless abandon. Let’s find out if prior authorizations (and other paperwork) are good at saving insurance companies money without the free labor of doctors. If so, then they should have no problem compensating us for our work. If not, the bureaucrats who make the decisions will notice the true cost of this nonsense and begin to decrease the load. Either way, doctors and patients win.
In the meantime, I guess I will continue to whine…and dream of possible solutions.
Happy New Year to all IMPs! Do you have something to say? A nice story to tell? Join us in making the IMP blog successful. The more voices, the better the blog (and the less whining from me). Even one blog every few months would be a great help. E-mail me at firstname.lastname@example.org to let me know you want to help out. Thanks!!