Why Should Physicians Be Underlings?

[Guest guest]

From Medscape General Medicine™

Webcast Video Editorials

Why Should Physicians Be Underlings?

Posted 07/08/2005

Rushika pulle, MD, MPP

There has been much written about the crisis facing American medicine.[1]

While it is tempting to assign the blame to others, such as lawyers, the

government, and certainly the insurers, perhaps we ought to spend more time

looking in the mirror. As Shakespeare suggested in Julius Caesar, " The

fault, dear Brutus, is not in our stars, but in ourselves that we are

underlings.[2] "

Over the past several years, I believe we American physicians have made many

wrong decisions for which we are now paying the price.

The first, and biggest, was selling our souls by taking on the role of

gatekeeper. While this may have led to higher incomes in the short run, it

violated a central tenet in the centuries-old covenant between ourselves and

our patients -- that we worked for them, and were their advocates.

Second, we have allowed the payment system to determine how we practice

medicine. We make patients come into the office for many things we know

could be better dealt with by phone or by email, because we are paid for

visits and not for remote interactions.

Thirdly, in all but the largest systems, we have ceded the management of

chronic illness to disease management companies hired by the insurer. It is

our job to manage disease, and with our real clinical data and relationship

with our patients we can do it much better.

Finally, we have failed to embrace the use of information technology in our

care. The arguments about return on investment are irrelevant; it is simply

absurd (and unsafe) to practice medicine in the year 2005 with paper charts

and handwritten prescriptions.

Imagine if we all simply stood up and said enough is enough. Together with

our patients, we, and not the insurers, lawyers, or bureaucrats, will

determine how to deliver care. And we will determine how we get paid, in a

way that reinforces doing the right thing.

Together, we have more power than we think. It's time to stop being

underlings.

That's my opinion. I am Dr. Rushika pulle, Co-Founder of Renaissance

Health and Clinical Associate, Massachusetts General Hospital.

References

L. The end of primary care. New York Times Magazine. April 18,

2004:52-55.

Shakespeare W. Julius Caesar. Act 1, scene 2, lines 140-141.

Rushika pulle, MD, MPP, Co-Founder, Renaissance Health and Clinical

Associate, Massachusetts General Hospital, Boston, Massachusetts. Email:

rf@...

Readers are encouraged to respond to Lundberg, MD, Editor of

MedGenMed, for the editor's eye only or for possible publication via email:

glundberg@...

Disclosure: Rushika pulle, MD, MPP, has disclosed no relevant

financial relationships.

Medscape General Medicine. 2005;7(3)

[Guest guest]

From Medscape General Medicine™

Webcast Video Editorials

Why Should Physicians Be Underlings?

Posted 07/08/2005

Rushika pulle, MD, MPP

There has been much written about the crisis facing American medicine.[1]

While it is tempting to assign the blame to others, such as lawyers, the

government, and certainly the insurers, perhaps we ought to spend more time

looking in the mirror. As Shakespeare suggested in Julius Caesar, " The

fault, dear Brutus, is not in our stars, but in ourselves that we are

underlings.[2] "

Over the past several years, I believe we American physicians have made many

wrong decisions for which we are now paying the price.

The first, and biggest, was selling our souls by taking on the role of

gatekeeper. While this may have led to higher incomes in the short run, it

violated a central tenet in the centuries-old covenant between ourselves and

our patients -- that we worked for them, and were their advocates.

Second, we have allowed the payment system to determine how we practice

medicine. We make patients come into the office for many things we know

could be better dealt with by phone or by email, because we are paid for

visits and not for remote interactions.

Thirdly, in all but the largest systems, we have ceded the management of

chronic illness to disease management companies hired by the insurer. It is

our job to manage disease, and with our real clinical data and relationship

with our patients we can do it much better.

Finally, we have failed to embrace the use of information technology in our

care. The arguments about return on investment are irrelevant; it is simply

absurd (and unsafe) to practice medicine in the year 2005 with paper charts

and handwritten prescriptions.

Imagine if we all simply stood up and said enough is enough. Together with

our patients, we, and not the insurers, lawyers, or bureaucrats, will

determine how to deliver care. And we will determine how we get paid, in a

way that reinforces doing the right thing.

Together, we have more power than we think. It's time to stop being

underlings.

That's my opinion. I am Dr. Rushika pulle, Co-Founder of Renaissance

Health and Clinical Associate, Massachusetts General Hospital.

References

L. The end of primary care. New York Times Magazine. April 18,

2004:52-55.

Shakespeare W. Julius Caesar. Act 1, scene 2, lines 140-141.

Rushika pulle, MD, MPP, Co-Founder, Renaissance Health and Clinical

Associate, Massachusetts General Hospital, Boston, Massachusetts. Email:

rf@...

Readers are encouraged to respond to Lundberg, MD, Editor of

MedGenMed, for the editor's eye only or for possible publication via email:

glundberg@...

Disclosure: Rushika pulle, MD, MPP, has disclosed no relevant

financial relationships.

Medscape General Medicine. 2005;7(3)

[Guest guest]

From Medscape General Medicine™

Webcast Video Editorials

Why Should Physicians Be Underlings?

Posted 07/08/2005

Rushika pulle, MD, MPP

There has been much written about the crisis facing American medicine.[1]

While it is tempting to assign the blame to others, such as lawyers, the

government, and certainly the insurers, perhaps we ought to spend more time

looking in the mirror. As Shakespeare suggested in Julius Caesar, " The

fault, dear Brutus, is not in our stars, but in ourselves that we are

underlings.[2] "

Over the past several years, I believe we American physicians have made many

wrong decisions for which we are now paying the price.

The first, and biggest, was selling our souls by taking on the role of

gatekeeper. While this may have led to higher incomes in the short run, it

violated a central tenet in the centuries-old covenant between ourselves and

our patients -- that we worked for them, and were their advocates.

Second, we have allowed the payment system to determine how we practice

medicine. We make patients come into the office for many things we know

could be better dealt with by phone or by email, because we are paid for

visits and not for remote interactions.

Thirdly, in all but the largest systems, we have ceded the management of

chronic illness to disease management companies hired by the insurer. It is

our job to manage disease, and with our real clinical data and relationship

with our patients we can do it much better.

Finally, we have failed to embrace the use of information technology in our

care. The arguments about return on investment are irrelevant; it is simply

absurd (and unsafe) to practice medicine in the year 2005 with paper charts

and handwritten prescriptions.

Imagine if we all simply stood up and said enough is enough. Together with

our patients, we, and not the insurers, lawyers, or bureaucrats, will

determine how to deliver care. And we will determine how we get paid, in a

way that reinforces doing the right thing.

Together, we have more power than we think. It's time to stop being

underlings.

That's my opinion. I am Dr. Rushika pulle, Co-Founder of Renaissance

Health and Clinical Associate, Massachusetts General Hospital.

References

L. The end of primary care. New York Times Magazine. April 18,

2004:52-55.

Shakespeare W. Julius Caesar. Act 1, scene 2, lines 140-141.

Rushika pulle, MD, MPP, Co-Founder, Renaissance Health and Clinical

Associate, Massachusetts General Hospital, Boston, Massachusetts. Email:

rf@...

Readers are encouraged to respond to Lundberg, MD, Editor of

MedGenMed, for the editor's eye only or for possible publication via email:

glundberg@...

Disclosure: Rushika pulle, MD, MPP, has disclosed no relevant

financial relationships.

Medscape General Medicine. 2005;7(3)

[Guest guest]

From Medscape General Medicine™

Webcast Video Editorials

Why Should Physicians Be Underlings?

Posted 07/08/2005

Rushika pulle, MD, MPP

There has been much written about the crisis facing American medicine.[1]

While it is tempting to assign the blame to others, such as lawyers, the

government, and certainly the insurers, perhaps we ought to spend more time

looking in the mirror. As Shakespeare suggested in Julius Caesar, " The

fault, dear Brutus, is not in our stars, but in ourselves that we are

underlings.[2] "

Over the past several years, I believe we American physicians have made many

wrong decisions for which we are now paying the price.

The first, and biggest, was selling our souls by taking on the role of

gatekeeper. While this may have led to higher incomes in the short run, it

violated a central tenet in the centuries-old covenant between ourselves and

our patients -- that we worked for them, and were their advocates.

Second, we have allowed the payment system to determine how we practice

medicine. We make patients come into the office for many things we know

could be better dealt with by phone or by email, because we are paid for

visits and not for remote interactions.

Thirdly, in all but the largest systems, we have ceded the management of

chronic illness to disease management companies hired by the insurer. It is

our job to manage disease, and with our real clinical data and relationship

with our patients we can do it much better.

Finally, we have failed to embrace the use of information technology in our

care. The arguments about return on investment are irrelevant; it is simply

absurd (and unsafe) to practice medicine in the year 2005 with paper charts

and handwritten prescriptions.

Imagine if we all simply stood up and said enough is enough. Together with

our patients, we, and not the insurers, lawyers, or bureaucrats, will

determine how to deliver care. And we will determine how we get paid, in a

way that reinforces doing the right thing.

Together, we have more power than we think. It's time to stop being

underlings.

That's my opinion. I am Dr. Rushika pulle, Co-Founder of Renaissance

Health and Clinical Associate, Massachusetts General Hospital.

References

L. The end of primary care. New York Times Magazine. April 18,

2004:52-55.

Shakespeare W. Julius Caesar. Act 1, scene 2, lines 140-141.

Rushika pulle, MD, MPP, Co-Founder, Renaissance Health and Clinical

Associate, Massachusetts General Hospital, Boston, Massachusetts. Email:

rf@...

Readers are encouraged to respond to Lundberg, MD, Editor of

MedGenMed, for the editor's eye only or for possible publication via email:

glundberg@...

Disclosure: Rushika pulle, MD, MPP, has disclosed no relevant

financial relationships.

Medscape General Medicine. 2005;7(3)