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Death of the Bedside Manner

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Death of the Bedside Manner

‘It is as painful perhaps to be awakened from a vision as to be born,” James Joyce wrote famously in his masterpiece “Ulysses.” I recently had such an experience when my office manager—who protects me from the daily insurance grind of referrals and approvals and pre-certifications and blood drawing—was out sick. Thus the veil was lifted from my eyes, and I awoke to the harsh realities of our medical future.

One patient was severely depressed and needed medication and a referral to a psychiatrist. Another was having trouble breathing from asthma that requires inhalers. A third had a faded rash on her arm that she was ready to call a spider bite until she showed me a two-day-old iPhone photo. It was the angry red rash of Lyme disease. Each problem had an effective treatment but each visit took over half an hour to carefully complete.

The appointments were gratifying, in an old-fashioned way. Patients still have the expectation that their doctor will be patient and listen carefully, but one by one doctors and patients are awakening from that comforting vision of the past to the rushed, restricted world of the ObamaCare future. Thanks to that eye-opening week without my office manager, when I ran hours behind, I was forced to forfeit the vision I had of myself as an old country doctor practicing in a big city.

For me and many of my colleagues, the real practice of medicine is supposed to involve an intimate encounter with each patient and a diagnosis of illness leading to a potential cure. In the future, however, a diagnosis of Lyme disease or the severity of a patient’s depression may be missed because showing the photo or taking an extensive mental-health history doesn’t fit squarely into the 10-minute visit authorized by insurance, along with mandatory computer documentation, insurance verifications and appointment scheduling.

These problems predate ObamaCare, but the new law brings more regulations and low-quality insurance at a time when we are already struggling to comply with the electronic health-record mandate.

Supporters of health reform will say that the Affordable Care Act didn’t cause all these problems, that President Obama shouldn’t be blamed for wanting to make sure that everyone has health insurance.

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