In the year that I've practiced I've made an important discovery: I am practicing medicine differently.  The biggest change is that I am not viewing patients in terms of diseases or problems, I'm focusing almost entirely on two things:

  1. Risk
  2. Quality of life.

The current system rewards care by using codes: ICD codes for diagnoses, and CPT codes for procedures.  Payment is given when these codes are submitted together, along with proper documentation of them being addressed.  The problem (no pun intended) is that people want to avoid problems and diagnoses.  You don't want to be sick, and you don't want things done to you.  The ultimate goal of the patient goes against the payment system.

Now that I am freed from that backward system, I can work to avoid problems or treat them while they are small.  I also can work to reduce the number of procedures, and in doing so I make myself more valuable to my patients.  This also frees me up to address the issue that matters most to people: quality of life.  Doctors seem to ignore this issue in many patients, as it is not part of the payment formula and so is a "free add-on" to care.  

I cannot stress how enormous and foundational this change is for both me and my patients.