Issue link: https://beckershealthcare.uberflip.com/i/534828
71 Question: From your perspective as a physician practic- ing in a small town, what do you think is right with health- care in the U.S.? Dr. John Haynes: Our expansion into technology has been fantastic over the years, with new antibiotics and other tech- nologies. We now have the latest devices in medicine with up-to-date diagnostic assistance at our fingertips. We can look up any treatment now, whereas before we spent a lot of time on the phone calling specialists in cities. Technology has been a huge plus for rural physicians. The Critical Access Hospital and Rural Health Clinic designations have also been a financial help and a big plus for rural medicine. Dr. George Franklin: Healthcare is still by and large available to the majority of people. It's still accessible. There are a lot of limitations, but people by and large can still get reasonable high-quality care. I'm not optimistic about the future of health- care though; I'm not sure there is a lot right with it. Dr. Robert Bosl: The absolute quality of care being provided is as high as it's ever been. The good feeling physicians get about practicing medicine is based on the relationship that de- velops in the exam room. All the positive things about health- care occur in the direct interaction of the physician and the patient; everything else that gets in the way can be frustrating. Q: What do you think is wrong with healthcare in the U.S.? Dr. Haynes: Government interventions in medicine have caused a lot of problems. They are compounding the problem instead of fixing the problem. I've been in practice since before Medicare. When it came in, I really thought it was a fine thing — and it is a fine thing. I thought the Medicaid program was a good thing too for those who were truly indigent and unable to support themselves, but these programs have been seriously abused. One other thing is the EMR is destroying the time-honored phy- sician-patient relationship. We are losing the art of medicine with these machines. When the EMR was introduced it was supposed to be time-saving, but it's anything but. The time it takes to put information into the EMR takes two to three times longer than the old way with paper. Residents are wasting time putting information into a machine when it could be done by paramedical personnel. Dr. Franklin: Non-medical people, usually third-party payers and pharmaceutical benefits companies, making medical deci- sions is unquestionably the biggest problem with healthcare in the U.S. They often want us to prescribe drugs we aren't comfortable with before more expensive ones. The divorcing of the patient and physician relationship has also dispelled an ill omen for the future of healthcare in the U.S., and I'm not optimistic. I think we are headed toward a Cana- dian type of system where healthcare is rationed. Dr. Bosl: My personal opinion is too little time and energy is spent taking care of patients and too much time and energy is being spent on the administrative parts of delivering care. Our society is not getting a good bang for its buck when it comes to health insurance. Too much is wasted on the administrative level at insurance companies and even more so at the clinical level because we have to jump through so many hoops just to keep the insurance industry happy. This includes quality mea- sures and prior authorizations for medications, among other things. There is too much insurance oversight. Q: How do you interact with your patients? As a rural phy- sician, do you have a special relationship with your pa- tients? Dr. Haynes: You know [patients'] families, their fathers, their mothers and their children. You watch kids grow up and be- come successful. You set their broken arms, take care of their earaches and sore throats. It's a special relationship in a rural area; I can assure you. I know my patients as babies and watch them grow up. You feel proud that perhaps a tiny little part of you helped that child grow up. It's really been fulfilling in that respect. Dr. Franklin: The way I relate with my patients is as a patient advocate. The single most important element is the patient- physician relationship and physicians can't forget that. Physi- cians' primary duty is to the patient, not third-party payers. There is no trick to interacting with patients. I had a large, fairly urban practice and the relationship with my patients was the same as it is now — there aren't any differences except that my patients now may have to drive larger distances to see me. The patient relationship stays the same though. It's strictly lo- gistics. Dr. Bosl: The rural family physician is much closer to their pa- tients emotionally because they attend church with patients, they play basketball with patients and they see patients in the grocery store. There is an emotional connection that way. On the other hand, the care we provide is probably a higher level of care because we know how that patient functions in their present social setting. We know what is important to them; we notice things about patients on the street that have an im- pact on their care. We see patients in the context of their over- all social system and we know a lot about what their stressors are — family stresses, work stresses, community stresses — these are all part of what brings patients in sometimes. Q: Why did you decide to move to a town with such a small population? 71 Physician Affairs "The rural family physician is much closer to their patients emotionally because they attend church with patients, they play basketball with patients and they see patients in the grocery store." — Dr. Robert Bosl