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Subject:  Re: OT: Career crisis Date:  10/18/2005  3:16 PM
Author:  SeattlePioneer Number:  212791 of 312945

Hello, XRaymd---

I'm very sorry to hear about the difficulties you are facing in your profession. I've read the thread on the other board, and this one to this point.

You have addressed the attempts people have made to help, but no good solution seems to have presented itself.

The best paragraph from my blue collar point of view is that by rozina:

<<In the meantime, make a committment to yourself. You will do the EMR with the patient in the office. If that means having to have a 30 minute or 45 minute block per patient instead of 15 minutes, then that's the way it will have to be for awhile. With you taking the work home with you, only you feel the pain. The pain has to be felt by your collegues before their best interest becomes your best interest.


You have a system that doesn't really doesn't work. Your senior doc doesn't use it and recognizes that he can't do the high quality work if he uses it. Other doctors wind up making unprofessional compromises that will eventually come back to harm them and the practice.

One doctor has devised methods that work.

So what to do? Well, I'm no professional. I was once a union business agent who sometimes sometimes problems with management imposing unreasonable conditions on employees. The paragraph quoted above appeals to my sense of holding the MANAGEMENT responsible for the decisions they have made.

Management is perfectly capable of imposing lousy systems on employees and making it stick if employees make enough compromises to keep a bad system limping along. But eventually a bad system's faults can't be glossed over: someone dies or is seriously injured because the system didn't work right. You get sued. Too many people quit. When management feels the pain, things will change. As long as only employees are feeling the pain, everything is ducky.

Unions can protect people from unreasonable demands by employers, and employees can't be forced into making unsafe compromises to enable a bad system unless they choose to do so. If enough employees cooperate to make the faults of a bad system or policy painful for management, it will be changed.

Unfortunately, you don't have that kind of protection. The doctors who are making compromises in their documentation are exposing themselves and the practice to liability, but that fact is hidden or glossed over for the present. You are reacting to the situation by killing yourself with overwork and still not meeting the production expectations of the practice management. The top doc recognizes that the system is badly flawed, but uses the power he has to escape from the system by not using it himself.

A true professional practice is quite special. It involves colleaques who trust and respect each other, and are committed to excellence rather than merely paying the bills. In such a practice, your concerns and those of your colleaques would not be ignored, but would be confronted and resolved in a way that promoted excellence for both patient care and physicians. Instead, you are being treated as the object of management power plays as they attempt to prove that square pegs do fit in round holes, if you have a big enough hammer.

Long term, I very much doubt that they have a big enough hammer. Their only real hope is a new edition of the software that solves many of the problems you describe (any hope for that?).

Your other options appear to be making the same compromises your other colleagues do, which you do not want to do. Or finding a new job. Or soldiering on in hopes that the system will be seen to fail before they hand you your hat.

You make a great case for unionizing physicians in your post, but I suppose the practice is too small for that to be especially practical.

Sorry I can't offer any good solutions. But perhaps your situation illustrates why we blue collars have formed and joined unions from time to time.

Seattle Pioneer
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