One of the main things driving  me back to blogging is madness.  While I can’t be sure that I am not overcome by madness, it is not my own of madness I am referring to.  Well, no, I am mad, but not mad in the way that I hear Elvis whispering in my ear or think that the squirrels are evil robots put there by aliens to spy on us.  The squirrel theory may be true (evidence does strongly support it), but it’s not that kind of madness I am talking about.

I am angry at the madness of our system.

I am angry when patients come to me after a two week hospitalization and I have no records or even an idea that they were hospitalized.  I am angry when I have to rely on my patients to find out what happened at the specialist, the emergency room, or in the hospital.  I am angry at all of the money that is being wasted on useless and sometimes harmful care and is done because nobody knows what is going on with patients.  I am angry when my life is spent chasing around ever-changing drug formularies and drug “shortages.” I am angry when my patients have to wait for a three-hour visit with a specialist who I recommended, only to have their complaints ignored and their questions unanswered.

I am angry about the political game of chicken that is regularly played by congress with Medicare reimbursement.  I am angry that it is far more lucrative to document than it is to care for patients.  I am angry at all the time I spend more time every day dealing with rules and regulations I don't understand than I do deciding what's best for people's health.  I am angry that electronic record systems pay more attention to "meaningful use" certification than they do to making their systems be useful in a meaningful way.

I am angry at doctors who prescribe narcotics like candy and then send me their patients when the DEA investigates.  I am angry at patients who try to fool me into prescribing drugs they are not taking, but selling.  I am angry that there are no psychiatrists available and so I am forced to perform amateur psychiatry on them in a 15-minute visit.  I am angry that my patients assume their doctors know their medical history when they don't, and that doctors assume the patient knows their medical history when they don't.

If any other business operated like health care, it would go out of business and the people who ran the business would go to jail.  I am serious.  People are gouged by our system and are given terrible care in return.  More and more I am seeing why people no longer trust the medical community and are turning to alternatives.  If our system is treating them poorly, they find someone who will do otherwise. I can't blame them.

And guess what, folks; it's an election year!  Prepare for more madness.  Prepare for politicians who prey on the fear of the elderly by telling them the other party wants to kill them.  Prepare for simplistic, head in the sand solutions to the problem that avoid the real problem because doing so would lose votes.  Prepare for promises of bigger, better programs that will fix our bloated system.  Prepare for complete madness transformed by political spin to look like rational policy.

Yes, there is a lot of madness to be had.  Everyone can have their fill.  The fire hose of madness is waiting to knock over whoever stands in its spray.

All of this makes me sad.  I am sad because I sit in the room every day with people who are pummeled by this madness.  I am sad because the madness hurts people I am trying to help. I am sad because I know of things I could do to decrease the madness for my patients, but would be rewarded with a decreased salary.  I am sad because I have to choose between making a living for my family and giving the best care possible.  I can't have both.

People need to know how dysfunctional our system is, not on a political or sociological level, but in the reality of the exam room.  This madness is making the most committed doctors have second thoughts about their profession.  I didn't go into medicine to learn to "play the game."  We all deserve better than this.

Don't worry; I don't intend for this blog to be a whining rant.  I wouldn't have come back to blogging just to complain about problems without giving hope.  There is hope, but few people see it.  Perhaps the biggest tragedy is that many if not most of our problems do have real solutions.  I want to beat the drum of sanity.  I want to bypass the spin and rhetoric, the editors and publishers with agendas, and tell you what I see here.  At some point the little boy needs to speak up about the emperor's nakedness.  There are others saying it, but the voice needs to be loud enough to be heard over the societal cacophony.

Maybe once we do that, we can get that squirrel problem under control.

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