Who can you trust?

A recent survey suggested that 85% of Americans trust their physician. However, there are problems for health care providers.

• Those who look up information on the internet are less likely to trust their physicians. This self diagnosis and treatment can lead to biases. Usually, the internet information is incomplete and needs to be considered in a complete framework.
• Health care insurance, including medicare and medicaid, are expensive. The public naturally suspects that all this money goes to greedy "fat cat" doctors. The truth is that most of the money goes elsewhere, with physician providers, on average, getting much less of the insurance dollar than the administration costs.
• Bad apples spoiling the bunch. Occasional bad physicians are caught truly cheating the system or actually harming patients. Some people then believe that most or all physicians are cheating, but only a few get caught. Their passion for justice rises against these cheaters.
• Physicians are often conspicuous consumers. Fancy cars, nice houses, and the like all inspire contempt and beliefs in greedy motives behind any and all physician activities.
• Criteria for reimbursement are complicated, leading to confusion and spotty compliance in documentation of services. Even though these services are both needed and appropriately provided, an incomplete documentation is not by the book and a bureaucracy always runs by the book. In a tight financial climate, CMS has begun to go after providers who make errors of omission in documentation. As simple an error as using one wrong word in a multipage report can lead to a denial of payment and a charge of fraud. Review of a single chart can take a reviewer up to an hour. A physician cannot spend that amount of time making sure all the I's are dotted and T's crossed. There are too many sick people. The result is the presence of minor charting infractions on almost every medical record and occasional errors by almost every physician. CMS labels this as fraud and abuse, and bureaucratic minded people will agree.
• In spite of extremely expensive health care, people die. They die at home after being seen in the ER. They die in the hospitals, sometimes without even getting properly diagnosed. They die from the effects of surgery or medications. The system of reimbursement is based upon paying for services provided, not for outcome. Those who have lost a loved one only to get an astronomic bill are upset by the "greed" they perceive as being behind the bill.
• When people go to the doctor, they think they get too many tests. They believe doctors are trying to milk the insurance company by overtesting. Yet, if something is missed, no matter how unlikely, a trip to the malpractice attorney is often on the patient's agenda.
• There will always be a few kooks who believe that a giant conspiracy exists among doctors.

Doctors have to maintain the trust and respect of their patients and of society as a whole. Perhaps by following the latest internet reports, living less large, making patients take responsibility for missed diagnoses due to incomplete workups, cutting the obvious failures (dead patients) some financial break, and developing EMR/EHR/form based reports that cover all the bases of arcane documentation, doctors can again regain the trust of at least some of their patients.