Is the practice of medicine being dictated by billing codes?
Several decades ago … physicians wrote “notes” on their patients…. every patient had a chart, and physicians would make notes following each patient encounter, capturing such elements as past medical history, the story of the present illness, the findings of physical examination and laboratory testing, and plans for further diagnostic evaluation and care. This approach required the physician to think everything through and formulate a coherent plan. In a sense, every physician was a storyteller, and one of the signs of excellence was the ability to formulate a succinct but comprehensive and coherent account of the patient’s care.
Today, by contrast, a great deal of the medical record is composed by selecting items from lists of available choices and drop-down menus…. And in most cases, the lists of options are constructed as much or more for coding and billing purposes—making sure the practice or hospital complies with regulations and gets paid—as they are to foster good patient care.
And by bureaucratic protocols?
What matters most is not whether care was customized to the needs of each individual patient but whether the physician followed protocols meant to apply to all patients. As a result, the practice of medicine tends to undergo depersonalization, and physicians come to resemble functionaries in a production process, what some have called “assembly-line medicine.”
I call this “medicine by algorithm.”