When Bedside Manner Is A Must

Oncologist Mary Mulcahy supports a bill that would encourage doctors to provide end-of-life counseling:

The need for a bill is revealed in a recent study in the Journal of the American Medical Association.  As background, physician payment is currently based on a value assigned, by Medicare and Medicaid Services, to the physician-specific work. The hourly revenue generated by a physician providing a cognitive service, one that involves thinking, reasoning and judgment without a procedure, is $87. That same physician – if conducting a procedure such as a colonoscopy or a cataract extraction – will make more than $300 per hour for the physician time associated with that service. This discrepancy results in fewer physicians entering cognitive fields and less time allotted per patient, at a time when more people are living longer with chronic illness. Medical conversation, the intimate kind that often only occurs within an examination room in the presence of a physician, is not valued highly by the American health care system. …

Among other things, the new legislation will assign a code and value to the complex discussion of end of life planning. Some may argue that this cannot be compared to the complexity of a procedure such as a colonoscopy or a cataract extraction. However, having an advance care planning discussion that results in a documented care plan to reflect informed choices is a skill that must be taught, learned and practiced just as intensively as any medical procedure. A poorly conducted end-of-life discussion will leave a scar deeper than any surgeon’s knife.