1. Process vs. product. Computers are just machines. I repeat, they are just tools. Health information technology is a shell which houses knowledge and human ability. It is nothing more . Electronic medical records may either streamline our thought processes or make them more cluttered. They will not, however, lead to better or more perfect care. They haven’t yet, and they won’t in the future. And they are prone to be adulterated by commercial intentions. Looking for an answer to our complex health care problems here is like waiting for Godot. You can wait and wait, but no one is coming.
2. Role confusion. Physicians, nurses, and therapists are some of the most educated, expensive cogs in the health care machine. Forcing them to become secretaries, scribes, and box checkers is both inefficient and redundant. Furthermore, it doesn’t take a physician to make sure a patient has had a flu shot, colonoscopy, or pap smear. These are roles for nonclinical, low payed employees. Take them of the clinicians plate. Let doctors be doctors, nurses be nurses, and physical (and occupational) therapists do what they are trained to do.
3. Call it courage. Until physicians have the courage to practice sound medicine and are willing to deny inappropriate antibiotics, narcotics and futile care, we are lost. Until politicians are willing to forgo the electoral advantage, and vote for what is sound, we are handicapped. Until patients are willing to own up to their own unsavory habits and practice will and self control, our medicines are impotent.
4. In data we trust. Data is being collected on the backs of physicians and nurses who have no reason to insure its fidelity, and have almost every reason to fudge their answers to move on to the herculean task of treating their patients. Garbage in, garbage out. The medical decisions of a generation will be based on crappy, nonsensical, inaccurate information.
5. Right or privilege. Either health care is a right or it is a privilege. If it is the former, tax the American people more (like we do for roads and such) and implement a single payer system. If it is latter, then let the market have at it, and accept that the have nots will have not. This is how we do it in America. Somebody has got to choose.
6. In government we trust. Can anyone out there say Healthcare.gov? Need I say more?
7. Anti-intellectualism. Few would call the care of the human body a simple matter. Some would argue that it is remarkably harder than, oh let’s say, setting up a web site for a health care marketplace. So why ever would we consider shortening medical school, truncating residency, or replacing MDs with less trained practitioners? Anyone? Anyone?
8. The sands of the hourglass. My belief is that the number one determinant of quality health care is the amount of time your clinician spends thinking about you. In other words, most practitioners are relatively smart and caring. Mistakes are made when the amount of time relegated to the task is insufficient. Yet we add more and more trivial chores to each encounter without expanding the allotted time. Something has got to give.
9. It’s futile. We offer dialysis to centenarians, physical therapy to end stage lung cancer patients, and a bevy of harmful and costly treatments inappropriately. The main reason, of course, is that there is no such thing as futility in American medicine. We are so busy charging up the hill, that we fail to see that the apex is a ledge that we are about to fall right back off.
10. The foxes are guarding the hen house. Do we really think that pharmacy run clinics are going to be the savior of our access problem? Are we to trust expert opinions from specialists when their suggestions are both self serving and run counter to what our best data tells us? Should politicians wield so much legislative power when they receive financial support from pharmaceutical companies, insurers, and the device industry? Why do we have so much faith on those who have their hands in the cookie jar?
If we want to meaningfully reform our health care system we have to take a hard and difficult look at ourselves. I’m willing to own up to my professions role in this horrible debacle, are you?