Doctor on the screen

You know the drill. You go to your primary care doctor and indirectly talk into an Electronic Health Record system. The doctor gives some bare attention as the nurse or assistant records the essentials. The doctor’s time is spent on paperwork and not on his/her judgment and diagnostic feeling; the patient just data. Worse yet, you may have a phone or video appointment (sometimes from silly vaccine mandates). The human is taken out.

As the late Charles Krauthammer wrote, EHR government mandates present you with just billing, legal documents, and degraded medicine. He pointed out that (in 2015) the supposed savings for the government with the move to EHR–$27 billion–was gone already. Unfortunately, EHR also made it easier for fraud with Medicare. Ease of use for the EHR system allowed cutting and pasting of data into data fields. Billing could be inflated.

At XiFin, I supported the company in the marketing department. Along with HIPAA compliance, we enabled form-fill features. Billing was simplified and waste rooted out. Still, there is still some waste, impersonal service, and the reflex to drug prescription.

As Krauthammer suggested, some tort reforms could improve the industry: No limits on a plaintiff’s lost earnings, a reasonable cap on pain and suffering ($250K), a similar cap on punitive damages, and serious penalties for frivolous lawsuits. These are tall orders, but he had the right idea.

He summed up with these suggested avenues for improvement: changes in public policy, malpractice reform in which loser pays all, separating routine treatments from major ones, and “allowing old age to take place.” (I don’t completely get this last one.)

Beyond the lack of personal care due to legal requirements, there is also the specter of Big Pharma. (Psychiatrists are one of the specialties in the prescription racket.) My views on healthcare have changed much from 30 years ago fresh out of college. I used to think that research and development were responsible for escalating drug costs, but the apparent collaboration in selling and prescribing is eye-opening.

In the U.K., my nan, uncle and aunt, sister and brother all of course get national healthcare. While I know my grandmother and stepgrandfather had various problems with scheduling visits and surgeries(!), I think my uncle, aunt, and siblings have had good services. My brother’s recent birth of his son was completely covered, my sister-in-law had in-home visits from maternity, and my uncle had successful hip work. I know the British are proud of their healthcare (they had dancing medical professionals in Olympic ceremonies), but I do wonder about more critical health needs. Some Europeans come to the top American clinics for advanced cancer care among other fields.

While I appreciate the advances here, I do feel a certain disconnect from a doctor looking down at a screen during an appointment that I had set up three months in advance. I think a redo is needed.

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