Every profession has it's own vocabulary. The vocabulary of medicine is notorious for it's complexity. "Inspection of the malar area revealed a patch of vitaligo next to a maculopapular rash that the patient states is puritic." Translation: "This patient has an area on her cheek that has both lost it's pigment and a rash that is visiable, palpable and itches." Dysuria means it hurts when you pee, excuse me urinate. A cholecystectomy is the removal of a patients gall bladder as opposed to a cystotomy which is making an incision in a cyst, even that big cyst that all of us have, the urinary bladder.
Today puzzling over what it is that physicians do, I realized that I went to school for four years to learn all these words. Then I spent another four years learning how to use them with other physicians while also learning to translate them back into a language patients can understand. Now that I am in practice, to get paid I have to use an entirely new language: Current Procedural Terminology or CPT for short.
CPT codes are numbers that insurance companies use to determine payment. The reimbursement I receive for a patient visit is based on the number of questions I ask, the number of body parts I examine and the time I spend explaining the diagnosis and treatment to the patient. All of this must be properly matched with a numerical code that is put into the computer and sent to the insurance company in order to receive payment. No one is ever told in medical school that the system is run this way. Why would anyone spend all that time learning a complicated language only to then learn some sort of Morse Code system so that the insurance company will pay you?
As I write this, I realize that in the practice of medicine I now use three languages. There is the language I speak to the patients. It is much the same that I use with friends and family. This language is English, hopefully as plain and simple as I can make it so that the patient I am caring for will understand what I believe is happening to them and what my plans are for treating this condition.
My second language is the one I use with other physicians and the health care team. I love this language. I have spent years learning it. I enjoy reading medical journals, talking with colleagues and attending conferences where it is used. The preciseness of this language is helpful in the diagnosis and treatment of patients.
This third language I consider a necessary evil. Without it I will not get paid. I am not proud of the fact that I know a 99213 is a specific level of office service or that V25.1 is the code for contraception counseling. These are facts that seem to clutter my brain. They do not make me a better physician or even a nicer person. Knowing this language only allows me to succeed at billing for my services.
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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