Remember Bill Frist? Heart surgeon? Former Senate Majority Leader? Super-genius doctor, such that he could make an authoritative diagnosis about a condition totally outside of his specialty based on videotape of a patient he did not otherwise examine? (Except whoopsie, maybe not?) That guy?
Turns out he’s got some questions about ObamaCare. Humble physician that he is, he relied not upon his own understanding of the law’s impact on doctors. No, he went to another trusted source — his own doctor.
Want real health reform that is in the interest of you and your family? Don’t make the same mistake that Washington did. In formulating ObamaCare, the politicians listened to lobbyists, policy wonks, academics, health theorists, regulators, and occasionally to each other. But they failed to listen to the people who actually care for patients: Doctors. Granted, the lobbyists for physician groups were at the table, but not the doctor him or herself. Ironic, isn’t it? Especially when it’s the doctor who has the daily responsibility of directly caring for the patient.
I wonder who this “the” doctor is. Which walking synecdoche would have been a decent stand-in for “the doctor him or herself”? Stupid me, when the American Medical Association, the National Physicians Alliance, the American Academy of Pediatrics, and the Association of American Medical Colleges all express support for a piece of legislation, I take that as a sign that at least some doctor somewhere has weighed in. Pity those poor lobbyists for physician groups, who I guess must have all agreed to support the ACA in secret without consulting any of the actual members. I’ll bet they must have caught hell when word got out.
Go ahead, ask your physician at your next visit what she or he thinks of current Washington-directed reform and its impact on the doctor-patient relationship. What you hear will likely surprise you, because it will likely be markedly different from what you hear from Washington. The policy theorists are simply too far removed from the reality of front-line patient care. Health reform, whether via the implementation of ObamaCare or the GOP’s “repeal and replace” plan, should no longer ignore the input and counsel of experienced, front-line, practicing doctors.
Here’s my own guess about what your physician will say if you ask him or her about ObamaCare — some variation on “hell if I should know.” Your doctor probably isn’t a policy wonk, and likely doesn’t have any special insight into the complex behemoth that is the Affordable Care Act. He might like certain aspects. She might think it is an unjust infringement on personal liberty. But your physician’s opinion of the bill is likely informed by his or her preexisting political opinion, rather than particular expertise.
Here is a sampling of what my own internist, who has taken care of thousands of patients over the past 20 years, shared with me:
Frist: We hear the electronic health record (EHR) will solve much of what ails our health sector.
Doctor: The EHR is not the savior of the medical system. In fact, it is effectively destroying the relational aspect of the art of medicine. Instead of talking with a patient and hearing her “story,” we are being relegated to looking at a computer screen and pointing/clicking during the visit. I know there are long-term benefits to an EHR, but most internists who value the art of medicine will tell you it is killing the “story.” And it is expensive. Physicians with EHRs see 15 to 30 percent fewer patients (and work later into the night). And yet with ObamaCare, we will be asked to take care of an additional 30 million patients. [emphasis gleefully added]
*insert “gales of laughter” sound clip here*
So, I work in an office with an EHR. However, we get new patients from other practices all the time, many of which come from offices that have yet to adopt an EHR system. That means I have to review the records before they are scanned into our computers. Would you like to know the “story” that I get, without exception, from these reams upon reams of photocopied charts? (Seriously, I have yet to review hand-written records that deviate from this norm.) Barely legible scrawled jots. Nigh unto worthless scribblings. Maybe internists are a different breed (color me skeptical), but from what I can tell EHRs have been an incredible boon to medical providers who want to know WTF the previous providers have written. When I get records from a practice that has its own EHR, I can tell what the hell they wrote! Whatever heartwarming “story” of physician-patient bonding those handwritten notes comprise in their one or two lines of chicken scratch, it may as well be in cuneiform to me.
And I don’t know where Frist’s doctor is getting those figures. If you are facile with the EHR you use (and some of them suck, it’s true), you can see patients no less efficiently with them. In fact, on those rare occasions when our computers are down and I have to use paper, it takes me much longer.
If your doctor doesn’t use an EHR, your doctor is doing you no favors. You should consider finding a different one.
But increased documentation in charts and billing surely improves value to the patient?
Hardly. We are now working with 17,000 diagnosis/billing codes — absolutely ridiculous. There are nine codes for abdominal pain (right upper, left upper, right lower, left lower — you get the idea). And the government has recently increased the number of codes from 17,000 to 155,000. The bottom line — 300 codes would probably cover everything. It could be printed in a four-page leaflet, not three large volumes. It is unnecessarily complicated and it does absolutely nothing to improve patient care.
Curse you, “government”! You and your regulations!
What Frist’s internist is griping about are the ICD-9 and ICD-10 diagnosis codes. I will happily concede that they are byzantine in their complexity, and I would be delighted if they were simplified. What that tricksy doctor doesn’t mention is that the ICD codes are published by the World Health Organization, and as far as I can tell have nothing whatsoever to do with ObamaCare. (Someone please correct me if I’m wrong.) Insofar as the Obama administration has had anything to do with ICD-1o code implementation, it has actually pushed back the deadline for the switch to allow healthcare providers more time to adapt. Turns out “the government” is a complex entity, much of it having nothing to do with the Affordable Care Act at all! If Frist’s doctor doesn’t understand that, then maybe we shouldn’t pay much attention to Frist’s doctor’s opinion.
This post is already approaching “too long” territory, so I’m going to refrain from going through the remainder of the article paragraph by paragraph. It goes on to imply that EHRs increase fraud (citation needed), rail against regulations and paperwork that have nothing whatsoever to do with ObamaCare (eg. admit notes to nursing homes, order forms for devices, etc, all of which have been around for ages), and to denigrate nurse practitioners (who I think are great). Suffice it to say that I found the whole piece totally unconvincing, and hardly a rousing endorsement for the policy expertise of physicians as a group.
So for the next round of reform, let’s make sure we don’t ignore the insights of real-life doctors. Let’s make sure this time around they are at the table.
Great! Let’s just make sure the doctors we invite know what they hell they’re talking about before they show up at the table.