American health care: The problem of always wanting more I remember going to see the movie “Oliver” in the theater when I was a kid.  Since this was my first movie in a theater, my mom made me a treat: a bag full of raisins and chocolate chips (Raisinets for Dutch people) and sent me there with my sister.  It was a fine film, with Oliver getting kicked out of the ...

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“Patient engagement.” What is patient engagement?  It sounds like a season of The Bachelor where a doctor dates hot patients.  It wouldn’t surprise me if it was. After all, patient engagement is hot; it’s the new buzz phrase for health wonks.  There was a even an entire day at the recent HIMSS conference dedicated to patient engagement.  I think the next season of The Bachelor should feature a wonk at HIMSS ...

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I’ve been going about this all wrong. It’s not my dumping of the payment system so I can focus on care over codes, my use of technology to connect better with patients, or my vision of the “collaborative record” that is wrong.  It’s the fact that I am doing this without my most important resource: my patients. I realized this while driving in to work this past week.  My first patient was ...

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It feels like part of me is dying.  I am losing something that has been a part of me for nearly 20 years. I bought in to the idea of electronic records in the early 90′s and was enthusiastic enough to implement in my practice in 1996.  My initial motivation was selfish: I am not an organized person by nature (distractible, in case you forgot), and computers do much of the ...

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It’s been a month since I started my new practice.  We are up to nearly 150 patients now, and aside from the cost to renovate my building, our revenue has already surpassed our spending.  The reason this is possible is that a cash-pay practice in which 100% of income is paid up front has an incredibly low overhead.  My admitted ineptitude at financial complexity has forced me to simplify our ...

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Only one company can deliver the perfect EMR: Google For the record: I am a geek.  I love technology.  I adopted EMR when all the cool kids were using paper.  Instead of loitering in the “in” doctors lounge making eyes at the nurses, I was writing clinical content and making my care more efficient.  I was getting “meaningful use” out of my EMR even when nobody paid me to do it.   But ...

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Since I started my new practice, it’s been an über hectic and very draining time, but I am happy to report that the end of the week was significantly better than the beginning. Here are some things I am learning. 1. Starting a business is really, really hard. I did my best to make my business as simple as possible, mainly because I understand my own deficiencies when it comes to business-related activities. ...

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Patients don’t matter as much as payment in our system Ok, I’ll admit it: I had no idea.  I thought that the whining and griping by other doctors about EMR was just petulance by a group of people who like to be in charge and who resist change.  I thought that they were struggling because of their lack of insight into the real benefits of digital records, instead focusing on their insignificant ...

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It has always been my assumption that my new practice will be as “digital” as possible.  No, I am not going into urology, I am talking about computers. [Waiting for the chuckles to subside] For at least ten years, I’ve used a digital EKG and spirometer that integrated with our medical record system, taking the data and storing it as meaningful numbers, not just pictures of squiggly lines (which is how EKG’s ...

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Is Lance Armstrong really a bad guy? “Lance Armstrong is a bad guy who has done some very good things.” These are the words of a sports radio personality I listened to yesterday.  He was obviously commenting on the confession (to my pal Oprah) by Armstrong about his use of performance enhancing drugs.  The sportscaster, along with many I heard talk on the subject, were not as upset by the ...

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