Physicians who want to stay employed have heard the time-crunched message. Dissatisfaction and some patient turnover are now expected, but also unnecessary. Johns Hopkins's Debra Roter and colleagues recently documented very high satisfaction with visits that just discussed problems of daily living, feelings and social relationships. Contracts are the bane of many physicians' existence, because many of us were never trained to read them, or have been too naive to hire someone who can. The doctor-patient relationship now usually depends on a payer for its existence, and the real payer is the employer.
Health insurance is linked to employment, and job security is history.
When Congress legislates how many days a patient should be hospitalized, or what disease du jour should receive special allowance, the quality of care goes down. Doctors and patients, not legislators, should make therapeutic decisions. Managed care could provide the very best for our patients and tap our creativity and compassion. It could reward patients who do more for themselves. It could find diabetics and hypertensives just as soon as they enroll, and prevent complications.