Doc Ippel: An Endangered ‘Small Business’

November 12, 2014

By Bruce Ippel, M.D.

I have a small business — a service business — but it’s not like your accountant or plumber or lawyer. I’m a doc, a family doc. And I can save your life or at least make it longer and more pleasant.

I’ve been in this business a long time. I see children of patients I delivered . . . and occasionally I might have even delivered the grandmother. I stopped delivering babies 20 years ago. I didn’t stop practicing medicine, though. I hope to continue until I can no longer score well on the specialty board exams. I hope so because it’s not only a privilege and a joy but it still is possible to run a good private medical practice.

That may be changing.

Now, I know there are likely better — even much better — ways for me to practice medicine. I would like our healthcare system to give me incentives to find those ways. I also would like spring to last all year. Since I rarely get what I like, I have learned to work with what I have.

What I now have is a system that has gone from encouraging doing what’s best for the patient to a system that now punishes me if I don’t do what the system says is best for it.

To summarize, it is getting seriously harder to serve individual patient needs while pleasing the system — so hard that I’m now worried that I will no longer be able to “work with what I have.”

For example, my experience tells me that some patients do better with a treatment that their health system doesn’t include or cover. I can try to fight the system to get that treatment, but there’s punishment in that, too. So I do what I’ve learned to do over the years. I find a back-door treatment that the system doesn’t know about — yet.

But the system’s ideal today is one size fits all (usually the cheapest size). What’s even more frustrating is that the patient has no right to choose an “inappropriate” treatment in many of these all-encompassing health-care systems, a treatment that in fact may be best for him.

Another important example is continuity. I mentioned that I regularly see patients at my clinic whose family have been patients of mine for generations. That kind of continuity is, perhaps, comforting but probably not all that important in giving good medical care. But what’s come about is the annual shuffling of the deck. Patients are presented with the complicated, confusing job of picking the “best” contract to sign for their next year’s health care. What is often hidden in that contract may require them to see the system’s contract doctor, who may be not only someone whom they’ve never seen but who practices at a mega clinic in a city an hour’s drive away.

Worse, the current health system now mandates the wonder of the “electronic medical record.” In the old days, maybe five years ago, if you transferred to another doc you’d ask that a copy of your records be sent there. The doc’s office would copy the pertinent data and include prominent notes on that patient’s important idiosyncrasies.

Not anymore. Such snail mail is thrown over in favor of electronic transfer. However, I’ve encountered at least two major glitches with this hot-shot miracle. The new chart is now a huge file of infinitely repeating gobbledygook. You look long and hard to find the important needles in the haystack of computer-generated details — such as copious time stamps, computed down to the second, recording when everything happened, including long lists of medicines the patient has had prescribed from forever.

Also, the systems don’t talk to each other; you can’t simply put the dozen or 20 important sheets in the back of your folder. No, it usually has to be faxed through cyberspace. If it ever arrives, then you have to either spend an hour or two sifting through the 400-plus pages to print out some things that look valuable or simply put it on a disc that you will never see again.

There’s quite a bit more, but you get the point.

Bruce Ippel, M.D., is a solo rural family physician in central Indiana and an adjunct scholar of the foundation. He and his wife of 42 years have 10 children. For the last 38 years, Dr. Ippel he has run a private “hardscrabble” clinic serving the under-served.



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