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Why has it become more difficult for doctors to provide top notch patient care?

I am glad to be back after taking some time away from writing. In the last 7 months, my father died of Multiple Myeloma after a 4 month hospitalization, followed one month later by the death of a very close friend and surgeon of a cardiac event at 50 years of age. He felt great the morning of his death and even did his usual exercise routine including surfing in Malibu. It has been tragic to say the least and despite being a cardiothoracic surgeon has made this process no easier. I still cry daily as my father was not only my dad, but also my best friend, advisor, and pal.

There is so much to write about as not only have recommendations for cholesterol management taken a 90 degree turn away from the original plan, and now the American Heart Association recommend high and higher dose statins to patients at risk because it will drive their bad cholesterol lower and lower, which actually is viewed by most of us in the field who actually see patients daily, as harmful and not in line with evidence based medicine. To counter this, the National Lipid Association is writing actual guidelines and recommendations that are long overdue and is composed by a panel of experts who are the most respected physicians, who have no agenda but to further care based on the best current medical evidence. I will discuss this in upcoming articles.

I think it is most important to talk about how the climate of medicine has changed literally overnight. As electronic medical records have been essentially mandated by the government, it has been a disaster for many physicians who thought it would increase efficiency and productivity and personally has made it a daily challenge whether or not spending 20-30 minutes on one refill from a pharmacy electronically and some days there are 50, is worth it. Patients do not understand what has gone on now that CVS Caremark has bought Medco as one example. Original scripts that patients have been on for their cholesterol or diabetes management are being denied and changed without physician approval from Medco to CVS Caremark and I spend hours on the phone fighting with insurance companies and at the end of the day, the patient is angry at me and I have been threatened about complaints to the medical board for changing medicines that worked. This is done often without doctor approval. Patients have to assume some role in their own care because physician burnout and suicide is increasing to all time highs. More time is spent doing paperwork, dealing with unhappy patients, more paperwork, electronic medical records which are not universal, often cannot provide what is advertised, and make it impossible to increase productivity. Ultimately, those of us who take insurance and Medicare will have to make choice if things do not change soon. The government has no right sticking their nose in healthcare the way it is being done and I can assure you that paper charts locked up were more HIPPA compliant than some EMR programs. In fact there is an article yesterday on August 29 in the WSJ titled “Why Doctors Are Sick of Their Profession”. It sheds some light on the problems but is not forceful enough. Once again, many patients think this is the fault of the doctor who cannot spend an hour with the patient any longer and have higher copays and deductibles, all of which result often in patients threatening their doctors. These patients, as well as their friends, disgruntled ex-husbands, ex-wives, ex-girlfriends, and ex-boyfriends can go on any free site like Facebook and Twitter, as well as those sites designed to serve as a complaint forum and literally post complete lies and accusations and one only need an email address to do so. A recent article from the Daily Beast says the best way to destroy a doctor is to Yelp them. Doctors who prescribe narcotics, sedatives, and stimulants for ADHD, many of which move from store front to store front get the best marks, while the dedicated ethical doctor who is still available 24/7 is bashed. In my next article, I will discuss how this sudden change in the dynamics of health care ushered in by the implementation of certain mandates of “Obamacare” has adversely affected cardiac care.

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