DOCTORS’ LOUNGE
LETTER TO THE EDITOR
Timothy A. Bratton, MD
L
ast night’s Democratic response on
February 28, 2017 by our former gov-
ernor of Kentucky does not represent
an accurate perspective of medicine from
the standpoint of a practicing Internist in
the Commonwealth of Kentucky. As a phy-
sician practicing in Kentucky over the last
15 years, I have experienced a lot of change,
most of which unfortunately has occurred
in the last five years. The push by the federal
government to use the Electronic Health
Record through the carrot of Meaningful
Use requires physicians to tote around a
computer from room to room. Instead of
looking patients in the eye during the en-
counter, I am focused on pressing on an
icon about whether a patient has had a fall
in the last year or asking about throw rugs
in the house. A consequence of becoming
a data entry operator is that I see about 15
percent fewer patients per day than when I
wrote in a paper chart. Another unintended
consequence is that over 25 primary care
physicians in the Louisville market have
transitioned their practices into a concierge
or retainer type practice. I am in the process
of losing two partners to this; as we recruit
to fill their positions as general outpatient
Internists, I am finding that it is like locating
a unicorn; they don’t exist. Physicians com-
pleting Internal Medicine residencies are
either becoming hospitalists or specialists.
We are beginning to experience a shortage
of primary care doctors.
Recently the cost of generic medications
has been gaining notoriety in the media. In
the last week, I saw a patient in followup
that I had seen in January for hemorrhoids.
I asked how he was doing and the gentleman
told me that the prescription was $1000. The
pharmacy was able to locate a generic form
for $250 but the patient had to drive one
hour to obtain it. That is a lot of money for
a suppository; when patients express their
concerns about the cost of medications I
am sympathetic, but I also let them know
we do not want the government to step in
and limit the price of a medication. If the
government limits the price, then there is
nothing stopping them from limiting what
you or I earn. The solution to driving down
costs is to increase competition and limit
regulations. As the Journal discussed several
months ago, the government is regulating
how many medications can be made on
assembly lines. I don’t remember any patient
telling me that they went to pick up Viagra
and got hemorrhoid cream instead as a re-
sult of a lack of quality control at a factory.
“If you like your doctor, then you can
keep your doctor” is also a farce. I had a
blue collar patient over one year ago change
doctors because he got into a state plan and
I was not on it. I hated to see him change
doctors as I had taken care of him for years
and he had become like family. Not only has
government health care limited the number
of patients I can see per day, it has dictated
who can see me.
Lastly, I seldom meet a patient who is hap-
py with the cost structure of their insurance.
Many have experienced increases in their
premiums and now have a deductible that
can be as high as $7,000. If you are truly
middle income America making a median
household income of $56,516 based upon
2015 data, a $7,000 deductible can contrib-
ute to a difficult financial situation.
that I went into medicine to take care of
Republicans and Democrats, Conservatives
and Liberals, Jews and Gentiles, U of L and
UK fans, gays and straights, rich and poor,
CEOs and union laborers. I make myself
quit typing and look patients in the eye and
remind myself that patients are not spread-
sheets but individuals who have loved ones
counting on me to get it right the first time.
I remind myself that I am not currently
going to transition to a concierge practice
as I have 1,400 patients counting on me to
make their lives better. I try to calm myself
down when I get the Prior Authorization
form from the pharmacy realizing that it
is important to get the medicine covered
at an affordable price so the patient can get
necessary meds.
I went into medicine to develop relation-
ships with patients and to make their lives
better for the 78.8 years that they are pre-
dicted to live on earth as Americans. I hope
that President Trump fulfills his campaign
promise and that Congress works with him
to change our health care system to Make
Medicine Great Again!
Frustrated, weary - but determined to
persevere.
Dr. Bratton is an Internist who has practiced
in Louisville for over 15 years.
For the time being, I keep telling myself
MARCH 2017
27