minutiarum said: I understand your gripes about reimbursement and EMR. But if it was properly implemented (give doctors money for equipment and staff training), do you think that EMR would improve patient care? What are your thoughts on the other aspects of the bill (Coverage for pre-existing conditions, requirement to have health-insurance, research on the effectiveness of treatments, etc)?
Thank you for taking the time to answer my questions. Your blog is amazing.
Ok, first of all — where is that money for EMR supposed to come from? That’s right: my taxes. Where will a greater proportion of the tax money come from? Hmm, well, who pays higher taxes: the patients who don’t have health insurance, or the doctors? Hmm…
But yes, in some magical world where real-life in-practice doctors could design an EMR program from the ground up, and be able to re-design/adjust it easily without layers of bureaucracy and non-medical software programmers clogging up the works, YES: EMR could improve patient care.
I think the concept of “pre-existing conditions" is an annoying yet realistic component of determining which patients will likely consume a greater portion of the insurance "pie". Now, if you have nationwide health care insurance that automatically covers all pre-existing conditions WITHOUT finding a way to compensate financially for the extra burden incurred by a diabetic-hypertensive-smoker, compared to a non-smoking healthy specimen of manliness (like myself), then the end result is: everyone pays the same amount into the pot (taxes), but some people will consume WAY more of that money. Fair? I think not. So then how do you make the math work out? Well, here’s an easy way: don’t pay the doctors equitably for the extra care and effort required for those complicated patients! DOH.
Requirement to have health insurance: I repeat, if nationwide health insurance has to cut back on reimbursement to doctors in order to make ends meet in the budget, why would any doctor want to accept that insurance? (“Will you be paying cash today, Mr. Brown, or will you be providing free car repairs for the doctor for the next month?”) So at that point, what good did it do to give everyone health insurance?
Research on the effectiveness of treatments = EBM (Evidence-Based Medicine). YES, I AM TOTALLY IN FAVOR OF THIS! It’s a concept which has really only showed up in med schools in the past 10-15 years , so the “older generations” of doctors still tend to use a lot of “in my experience" and "well I heard somewhere" (Anecdotal Medicine) to back up there current treatment practices without actually checking to see if the research backs it up! EBM is awesome.
But something else needs to go hand-in-hand with EBM in order for doctors to be able to practice medicine safely, relying on the research without having to worry so much about “But what if this patient is the 1 in a thousand/million patient that DOESN’T fit the research, and I get SUED?” — TORT REFORM. As long as patients can sue the pants/underwear/scrotal skin off of doctors because of a “random” unexpected poor outcome while attempting to follow EBM guidelines, doctors will continue to use the Shotgun Approach for patients: BLAST THEM WITH ANTIBIOTICS AND FULL-BODY SCANS AND UNNECESSARY HOSPITAL/ER VISITS AND TOO-SOON SPECIALIST REFERRALS, so that a future judge/jury can’t say “You didn’t do enough for this patient!” I can’t begin to estimate just how much $$ is WASTED each day by doctors ordering tests that won’t change their treatment plan, just to appease the patient (either because the patient is currently demanding the test, or because the doctor imagines the patient complaining later that the doctor DIDN’T do the test).
I have a colleague who regularly walks out of exam rooms with a throat culture swab, hands it to the nurse, and says, “Go ahead and do the strep test, but I’m sure it’s going to be negative." 5 minutes and one pointless test later, he goes back in the room and tells the patient, "Well, it appears you don’t have strep throat, because the test was negative.” ARRGH! You already knew the patient didn’t have strep throat, based on your physical exam! But that’s Defensive Medicine for ya — doctors are running scared of patients and their lawyers.
(So this whole post makes me sound like a greedy elitist doctor. Not at all. Our country should not have so many un-insured patients — it’s shameful. But the current health-care-reform bill(s) are really “Health-Care-Insurance-Coverage-Reform.” Hence my skepticism.)
Hope this helps. Sorry I took a while to reply — I always procrastinate replying to these “political” questions, cuz I hate the whole topic. :p
From the Archives: Cranquis and healthcare-politics do not get along.
There are a few good points here but the rest of it is so awful I don’t even know how to respond. I guess I’ll just address the pre-existing conditions rant.
Is it “fair” that some people get cancer? Is it “fair” that I was born with excess bone in my foot that keeps regrowing and requiring surgery (4 times so far!)? Nope, not really, unless you think people with cancer somehow deserve it. Why should people be penalized for things that are often not “fair”? Being healthy isn’t some wonderful thing you did. Much of it is luck. Why should you deserve a cash bonus for being lucky? Is that fair?
On average, smokers have lower incomes than non-smokers. A doctor I know in an area with mostly affluent patients has very few patients who smoke. People who smoke also literally pay a tax for doing so. You do not. In much of the northeast, it’s $2-$4 per pack, plus the federal $1.01 tax. A pack a day smoker is paying up to around $1800 a year that you do not.
People with lower incomes also often face grocery deserts and lack access to fresh fruits and vegetables. They often work multiple jobs in order to survive. If I worked 16 hours a day, I wouldn’t want to spend my precious hours of sleep and free time cooking a meal. The Dollar Menu would seem pretty enticing.
We live in a country full of unfairness. Your complaints suggest punishing the people already losing in our system simply for not living the way you think they should (and most likely, how they wish they could). I’m more than happy for “my taxes” to go to helping people out. It’s better than the 25% going to “national defense,” which means 10% for “ongoing operations” (see http://www.whitehouse.gov/2013-taxreceipt for a breakdown).