Appreciation--Doctor's Day

Yesterday my office celebrated Doctor's Day. The staff had been mysteriously cooking something up for the last three weeks so it was not a complete surprise, but what a great job they did. The hospital's theme for the day was "Our Docs Rock" so my staff chose a 50's motif. As I walked into my office there was a "vinyl record" suspended in the doorway with my picture and name on it. Walking down the hallway to the patient rooms, there were smaller "45" records hanging from the ceiling. Our receptionist had cleverly made poodle skirts from black tablecloths for all the front staff. They had hooked up someone's iPod and played a 50's playlist all day long.

Two other women practice with me, Dr. Kurowski and Dr. Irvin. Starting with a sparsely filled vase, each patient handed us a flower throughout the day until our vases were beautifully overflowing. One patient joked that he came to the doctor for allergy treatment and the first thing they handed him was a plant! He also told the staff that he felt like Henry Gibson, but the reference was lost on them. Too young! But the two of us shared a laugh and a memory. Every patient seemed genuinely happy to participate in the festivities. Assuming you like her, how often do you get to hand your doctor a flower and say thanks?

At lunch time the scheduled pharmaceutical rep didn't show so my office manager went out and bought White Castles. Luckily I had my gallbladder out last September so I enjoyed all six of those sliders, along with a cream soda float. The drink was something I haven't eaten since I was a teenager. (OK, maybe once or twice with my kids but not often). Then the doctors were presented with "platters" celebrating our years of practice. 

After lunch we all trooped to the waiting room where the Lab Corp phlebotomist was pressed into service and kindly took our pictures. I am the proud doctor in the middle. 

Death of a radiology clinic

As usual, I was considering blog topics as I entered my office this morning. Looking down there was a letter sitting on my desk. It was from one of the stand alone radiology offices in town, the one I personally go to every year for my mammogram. I go there because they are accurate, friendly, and efficient. However, because they were one of the busiest in town I always got a first morning appointment. This past January when I went for my yearly exam the waiting room was empty. One person came in while I was in there. Because Dr. Irwin knows me I went back to the reading room while she looked at my "films" (they aren't really films anymore, they are digitized images). She quickly reassured me that my mammogram was normal then we moved on to other topics. We have known each other for years and we talked about our kids and spouses. Then she asked me how I liked being an employee for the hospital instead of private practice (and oh by the way--another day, another blog topic!). Admitting just how much I did like it, she smiled and said she was glad for me. Then she said, "All our referring physicians are being bought by the hospitals so all our patients are staying in those hospital systems for their radiologic procedures. I hope you can continue to refer to us." She didn't say it, but I heard, "They are killing us out here".

While researching today's topic I found this article by a financial  advisor who seemed almost gleeful to report that hospitals might be able to purchase freestanding imaging centers at "depressed" prices due to current market forces which include reduction in reimbursement and continued increase in expenses. Depressed is the word, as I see the end of physician entrepreneurs and the furthering of corporate entities in medicine along with most other industries in this country. (If you are interested in further reading, here is an excellent, albeit technical, white paper on the issue: DRA's Effect on Imaging Centers).

Is this for better or worse? Who can say. So far, it is difficult for me to see a clear improvement in my patients' lives by this industrialization of patient care. I know we are supposed to be moving toward patient-centered care with ACO's and the medical home. With these new ways of delivering care, reimbursement formulas will change and who knows if this will improve or worsen care? Those studies are in process.

Today I know patients are not better served by being forced to go to larger centers, i.e. hospitals, for their imaging studies. And tomorrow? I just hope HAL is not in charge of the ACO's pod bay doors.