Today's guest blog by Dr. Donald Kamens, discusses the top ten things that have led to the
destruction of medical care in the 21st century. Unfortunately, the list
is endless. These are in no particular order, except to say, that the next item
is often more odious than the previous.
Here, then are some of things that have gone terribly wrong, and from
which we seem unable to turn back.
From a doc
of four decades, these are some of the forces that have served in the continual
and progressive plight of medical care. Here is what I think needs to be
eliminated from the House of Medicine: What do you think?
1.
DTC (Direct to
consumer) pharma ads. Think of it.
Can you remember when such a thing was actually a heresy? Illegal?
If so, you are older (like me!). Then, the sound of a jazz guitar did
not conjure up male performance anxiety and a reach for the pill. Then, all the
side-effects of any drug were not spouted off by fast-talking actors, and “tell
your doctor if…” were not fare for a commercial break. Most of you know that the doctor-patient
relationship is totally undermined by this crass pharma commercialism. Ads for pharmaceuticals needs to be made illegal
again. Let the doctor do the analytics and the deciding. This does not need to
be a patient activity, one more closely related to recreational substances than
to therapeutic medicines. At least allow the patient to choose whether to have
to listen, to hear, that baloney or not. And choose whether to explore through research
online or not. In the meantime, we could
let football games be football games, instead of marketing venues for various
chemicals. Sure, beer is a chemical, but it is fine. What to do: pull the plug on greedy pharmaceutical
manipulations that do well to nothing but confuse patients, and distort the
role of the doctor.
2.
Barriers to
doctor-patient relationship: The
prime examples here are EHR screens, creating ridiculous busy-work that makes
seeing patients like filling out tax forms, and increasing pressure to see more
patients in less time. Seriously?! Despite being an advocate of EHR from long
ago, and an early developer, they have gone to another universe. Now we have
complexity after complexity. The EHR is
such a pain, we have an ever increasing presence of scribes and other
assistants assigned to deal with the clerical. Does this not attest to the progressive
marginalization of the physician from the therapeutic relationship? What to do:
eliminate documentation criteria; eliminate reimbursement based on
completed charting items. A one line
should be good enough. “Put her on
antibiotics for the pneumonia, and told her to see her doctor and/or come back
if not better in two-three days, or if worse. “ Not much more needed.
3.
Liability. Little more needs to be
said about that nasty word, but just to be clear….here I am, on the way to
work; here I am going to go help someone today.
And they often need help it seems. But wait! I have to worry about being sued. Alost forgot!
I have to think about being hurt-back by the one I am trying to help-out.
Seriously? What to do: tort reform is not a good plan. Why?
The complexity of work-arounds would be just as overwhelming. Simply do this: eliminate liability. If you are there to help, you are there to
help. If you screw up, you screw
up. It is going to happen at times. The
house of medicine should not allow overwhelming vulnerability, hurt to the one
trying to help. Do it Shakespeare’s way, or make suing doctors illegal. If done, the costs of medicine will go down,
down, down.
4.
Reset the goals: Make patient outcome goals vastly more important than economic goals. More
important than throughput statistics. Outcomes do not have to be specific (e.g.
cure of coronary syndrome)...BUT Can be non-negative intermediate outcome
based. EG—the patient did not die in the
ED; or the patient feels better, now, though we do not have a definitive
diagnosis. Other examples of how this
has gone awry include readmission criteria -an economic goal gone haywire,
causing care to be stopped before its time 2. Inpatient census monitoring - the
goal should be zero census, as everyone would then be well 3- etc., etc.)
5.
Role
confusion - (no one more confused than
patients: who REALLY does what...doctor, nurse, PA, NP, pharmacist, unit
secretary............and the ubiquitous "I never got to see the
doctor"). Eliminate the vague uniforms.
Make it consistent with consistent name tags.
6.
Stating Lies, such
as health insurance = healthcare. (Being
"insured" in 2016 guarantees neither care, nor an affordable
bill)
7.
Middle men (modern medicine has seen an ascendency of
middle men, not only for pharmaceuticals, but also for devices, services, etc.
Too many hands in the pie, means the cost goes up, and up). Why (Why???) do you have to have 100’s of
companies trying to get a piece of the ACA or Medicare pie by offering to find
YOU the right plan? Why. Make is simple,
stop this stupid spending on overhead.
8.
Fostering of
unrealistic expectations - patients,
very often, expect to have something available that has actually not yet been
invented. It can be a world of science
fiction. “What do you mean that your
hospital cannot get/read the record from that place I was at over vacation???
“ You mean you cannot reverse my
husband’s stroke? On and on.
9.
Blindness: Here we are: what
you might see does not really matter; what is recorded does. Hard evidence (numbers & testing) has displaced observation,
history-taking, examination. (Ask any plaintiff's attorney).
10.
Stabilize the rapidly shifting medical model Pick a recent approach; stay with it as long as
possible. Get ready for change. Why? (During
the time from symptom to diagnosis may be enough time for accepted criteria for
a given entity to change). Too fast to keep up with.
#11 – 1000+ Get the EHR thing right: Look it is
ridiculous to have an ever increasing percentage of time spent on wrestling
with these things, time that could be used for patient care. There are not getting better. Even
the good companies know it. Government criteria are getting more and more
burdensome. The absence of true interoperability is not tolerable, especially
to patients who simply cannot understand why hospital X does not have the
information from hospital Z. Let alone why doctor A does not have the
information from doctor B at the same facility.
It is a mess. Acknowledge it. No
problem was ever solved without admitting it exists.
No comments:
Post a Comment