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Readers Write: Doctor’s Day and HIMSS

March 31, 2014 Readers Write 5 Comments

Doctor’s Day and HIMSS
By Dr. Wellbeing

On Doctor’s Day, I am reflecting on the morale of my profession. I hope to get away with being the kid who says, "The emperor has no clothes."

I looked long and hard for inspirational writings about doctors, particularly on this day, and there were none. Maybe the closest to a worthy read was Malcolm Gladwell’s article in Forbes about the state of American healthcare, followed by his interview called, "Tell People What It’s Really Like to Be a Doctor." It came as a surprise considering he is not an insider, but he is one of the most insightful thinkers out there. As such, I was happy to see a voice in defense of doctors.

Alas he is the exception that proves the rule. Because it seems doctors are blamed for everything that is wrong with the healthcare system these days.

CMS is making physician payment data public. Insurance companies are placing doctors in straightjackets and requiring pages of paperwork just to get one medication approved. Patients have unrealistic expectations of, "I can hardly wait to chat with my doctor at my leisure online."

No wonder the morale of doctors is at an all-time low. It is the equivalent of a big bully chasing the weak kid around on the playground because he is small and cannot fend for himself. Physicians historically have not been well organized, and their representatives – such as AMA — abandoned them a long time ago.

I just returned from my first HIMSS conference, where everybody was busy giving advice on how practices should get ready for ACOs, MU, ICD-10, PCMH, population health etc. I am thinking that maybe the ones who should have their data made public are the HIMSS folks themselves, since just to exhibit there for one week costs more than my salary for a year.

I am not returning anytime soon. Even though I was warned by close friends that HIMSS is physician-unfriendly, I was not prepared for the CEO and chairman to start the conference with an insult to physicians after asking them to stand up in a full room. One IT person who is equally disenchanted with HIMSS and vows to not return suggested that we should invite "60 Minutes " to one of those conferences. Or maybe some patients, for that matter.

The healthcare IT industry has become a bit like the tail that wags the dog. It has lost its sense of purpose and meaning. One of my favorite lines ever is from “Jurassic Park,” which is, “Just because we could does not mean we should.”

One vendor was shocked to find out that I am not paid for “population health.” Another one dressed in a white lab coat could not explain to me who makes the ultimate decision in telemedicine (one genie that left the bottle) when the patient with congestive heart failure whom we try to keep out of the hospital cannot breathe. Who calls 911 — the patient, his doctor, or the “doc in the box?” Nor could he answer whose liability that is. I have yet to see a tele-intubation.

If we are to have some foresight, then maybe we should have some hindsight as well and understand how we got here in the first place. The sickest patients, the elderly, the chronically ill, and nursing home residents are not technology savvy. Nursing homes have been beaten by litigation to the point that the fear of being sued is so ingrained into their psyche that they cannot even give a Tylenol or a laxative without a doctor’s approval. Hence, why every decision in healthcare goes through a doctor’s office whether we like it or not. It is why my inbox is full every day and I have endless hours of mind-numbing work.

Another EMR vendor could not articulate why a hospital should buy its care coordination solution when hospitals are not being paid for care coordination. Little do they know that very few actually participate in ACOs, nor do they plan to do so. As such, their solutions are based on assumptions that we will all be in an ACO one day, an experiment that has yet to show results, also ignoring the fact that 60 percent of doctors have expressed no desire to join one.

The whole premise of the HIMSS technology offerings relies very heavily on the Assume a Can Opener theory. It has very little understanding of how healthcare is being delivered and paid for, which I particularly found very disturbing.

The shortage of physicians and the burnout is real. On this day, let us all remember that in reality what we are paying docs to do is to make decisions. That is far more complex than any of the human endeavors or societal activities, and yet it is the most-intruded upon, most-regulated and most-distrusted of them all. In Greek mythology, Hydra grew two heads each time one was cut off, just as healthcare grows more complex by the day. Yet the ones who should be consulted first seem to be the last.

It seems the harder we try to fix the "broken American healthcare system," the farther we are from fixing it. The recent proof is the ineptitude of Congress, who is not capable  to understand the complexity of what  they are voting on, always approving short-term fixes to long-term problems. The sad part is not that the fee-for-service is broken or that the HMO / capitation / ACO is better, nor that they kicked the  can down the road regarding SGR for the umpteenth time, but that we are forced to practice in a a dual, ambivalent environment where both are equally approved.

While hospitals are paid by DRG, doctors are paid per day. In Medicare Advantage Plans, the Primary Care gets paid capitation, while the specialists get paid fee-for-service. We have created a de facto "divide and conquer" system.

Too often the term "physician alignment" is used along with "patient engagement " and "accountable care." How about if for one day a year  – March 30 — we use "patient alignment and patient accountability“ and "physicians’ engagement?” Because returning from HIMSS, my EMR inbox was full of messages like, "Can the doctor write me a note for early dinner sitting on my cruise since I am a diabetic?" or “Can the doctor write me a note for the airline to allow me to take my dog with me on the plane since I suffer from anxiety?" or "What kind of fiber should I take?"

I do believe strongly that patients should have access to their records and that healthcare records should be digitized, but  I do not subscribe to the assumption that it will resolve our healthcare woes or that it will lower healthcare costs. Just giving patients their data does not mean that they will know what to do with it, nor that they will make wiser decisions. Giving them an app does not mean that they will start eating spinach.

The same is true of physicians. Inundating them with data does not mean they will make better decisions, either. We are in essence data-rich but information-poor.

While I enjoyed networking and meeting people, it was difficult to separate the signal from the noise. I saw what billionaires look like, from Judy Faulkner to Dr. Patrick Soon-Shiong, who was gracious and took a picture with me so I can show my kids that the richest man in LA is a physician and not a movie mogul. But I cannot ignore the fact that not all hospitals can afford Epic and that so many had their credit ratings downgraded due to Epic implementations budget overruns, nor the fact that the orange-clad NantHealth staffers had no idea what their company was about. I also had the opportunity to explain to some why social media for many physicians is a legal minefield and many MDs shy away and don’t want to live in the town where they practice.

One economist said that when the barn is on fire, the farmer by instinct goes inside and saves the cat, the dog, and the livestock and leaves the rest behind. I believe it is time for healthcare IT industry to do the same. If healthcare is on the verge of a cliff, then healthcare IT can either throw us a rope or give us the final push. 

I keep hoping that someday the pendulum will swing back to doctors being respected and trusted and that they themselves rediscover the meaning and calling of their profession amid all the chaos. I should have faith because Mr. H told me so.

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5 Responses to “Readers Write: Doctor’s Day and HIMSS”

  1. 1
    Marshall Says:

    This is probably the most informative post I have seen in quite a while. Thank you, doctor (and all doctors) for what you do.

  2. 2
    HPS Says:

    I too have been skeptical about the rush to patient engagement as the solution for what ails the HC system. I don’t understand his disdain for IT vendors (I am not one) or HIMSS. Physicians are still very respected in my mind but the days of them having unquestioned authority and power are long past, for better or worse.

  3. 3
    TJ Jackson Says:

    I get what the writer is saying and actually agree with much of it (especially the burning barn story) but in my opinion, to say physicians are not respected is pretty inaccurate and screams ‘woe is me’. Says to me, my cheese is being moved and I don’t like it. Similar to most other professions over the years, as innovation happens, there is a good chance you won’t be doing what generations before you have done so I hope this writer and other physicians use their innovative abilities to help lead a more coordinated, customer oriented and sustainable model. Throwing more money and/or bodies at the problem does now lower or slow the trend of healthcare so to your initial point, time to completely deconstruct and rebuild the model (including potentially new roles, responsibilities, etc.).

  4. 4
    Don Says:

    Spot on, TJ Jackson. I have and always will have the utmost respect for physicians, RN’s etc, but they must come to accept that their role and the impact of technology is re-shaping the entire healthcare arena. Public education is facing the same dilemma. Teachers and administrators have to admit that the core infrastructure of teaching, like healthcare, needs to be radically revised. Agreed, throwing money and bodies at the probem within the confines of the current, out-moded model will not improve outcomes.

  5. 5
    Mobile Man Says:

    I’ve said it before and I’ll say it again… the “business of healthcare” (futile) combined with the law of unintended consequences drives us to places that NO ONE likes…

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