By Dr. Robert C. Reiser
First, let me apologize for the cookies and milk I left for you last Christmas eve. I did not realize that Mrs. Claus had put you on a gluten-free diet, and I should have recognized that a man of your years might become lactose intolerant. I hope you are feeling less bloated these days.
I write to inform you, ahead of my wish list, that I think that I have been a pretty good doctor this year. I have spent many hours away from the bedside complying with important regulatory requirements. Why, just last week I re-certified in Basic Life Support and CPR and I have a merit badge to prove it. This should come in handy in the ER; I have seen a few cases of cardiac arrest over the last 30 years and now I know what to do.
As mandated by the government I have reviewed my patient satisfaction scores, which curiously do not include admitted patients, so I don’t really know how satisfied my cardiac arrest survivors are. There aren’t many, of course, but maybe with this CPR training there will be more. I do know how I am doing with chronic pain patients: about average.
I have taken my yearly board re-certification test, my computer-based learning modules and my 30 hours of continuing medical education credits. I have eagerly read all of my quality improvement reviews helpfully provided by back office support staff, and I am working diligently to enter more stuff in the computer. Fortunately, I am able to hire scribes to tame the electronic medical record since a computer-based program that actually makes caring for patients easier seems to be still in the future.
I have updated my state medical license, my national board certification, my DEA license, my Physician Quality Reporting System requirements for Medicare, and my hospital privileges. I am now fully ready to start seeing patients in the coming year. I will need to set aside some time however to redo all of the above-mentioned requirements all over again.
So, I think by all the important measures I have been a good doctor and deserve to be on the nice list. I do have few quick suggestions for who else should be on the nice list and who should be on the naughty list.
Nice list: Nurse Kaci Hickox who spent four weeks in Sierra Leone treating Ebola patients. This was gutsy, compassionate, and reflective of the highest standards of the healthcare professions. Throw in all of the doctors and nurses who have been caring for Ebola patients both abroad and here in the U.S.
Naughty: Governor and bully Chris Christie of New Jersey who saluted Kaci Hickox’s service on her return to the U.S. by declaring her obviously ill (she wasn’t) without laying eyes on her and with no medical training, and clapping her into forced quarantine in a tent with no running water. Bad Governor!
Many were afraid such draconian measures might dissuade other healthcare workers from volunteering overseas, but I look at it another way. Perhaps more U.S. health care workers will stay in West Africa when they realize the living conditions there are marginally better than what they can expect if they come home.
Nice: Virginia Governor Terry McAuliffe, who has labored tirelessly to expand Medicaid healthcare insurance to cover 400,000 more poor Virginians. Over 90 percent of the cost would be borne by the Federal government under the Affordable Care Act. When a similar law was enacted in Massachusetts in 2006 (Romneycare) it was found that the death rate dropped dramatically, by close to 5 percent for healthcare associated deaths and overall by almost 3 percent for all-cause mortality. For every 830 people who gained healthcare insurance, one life was saved. Good job, healthcare insurance!
Naughty: The Virginia House of Delegates, who have consistently blocked the Medicaid expansion. We can expect 400 excess deaths this year due to lack of healthcare insurance as Virginia becomes one of only three states in the U.S. that has actually increased its percentage of uninsured residents since the Affordable Care Act took effect. Bad job, House of Delegates!
And now, Santa, for my Christmas wish list:
An electronic medical record that allows me to spend more time in direct patient care, not less. Ideally, I would not have to hire a full time scribe just to do the voluminous data entry that such systems seem to encourage.
Regulatory requirements that actually improve patient care.
A mini bike.
More nursing school graduates going into bedside nursing. They are the glue that holds our healthcare system together and they do the bulk of the caring and the healing in our massive system. We need to reward them appropriately.
A BB gun.
More MD and DO residency spots to train the ever-larger number of doctors we will need as our population grows and as the baby boomers continue to live longer and with more burden of disease. The number of residency spots paid for by Medicare was capped by the federal government in 1997 and has not been raised since.
An electric guitar.
Universal health care in the U.S. The richest country in the world ought to be able to care for all of its citizens.
I know some of my wishes may seem farfetched, but remember, Santa, it is never too late to have a happy childhood or an efficient and functioning healthcare system. Enjoy the bacon (but don’t tell Mrs. Claus).
Merry Christmas, Crozet!