Like the direction we are heading?
A couple recent medically related articles caught my attention.
The first was a study showing a 20% incidence of hospital errors – a shocking number at best! You can’t get into a clinic or hospital without the registration area putting an ID bracelet on you and triple checking your insurance info lest you accidentally get care without paying. Everyone then checks your ID before drawing blood, doing an x-ray, giving you a pill or whatever. If you have surgery, they put signs on where to make the incision. How can you make an error??? Maybe if everyone didn’t spend so much time double checking, you’d have time to avoid all those errors. I picked up an Rx recently and the charge machine had multiple screens, each requiring a signature. Was the privacy policy explained? Did the pharmacist explain the medication to me? Do I have any questions? Sign for the amount of the charge. 4 signatures in the credit card machine on different screens to get out of the drugstore. Am I missing something? Does anyone care about me or only about the regulations? If we are making a ton of errors, perhaps it is because we spend so much time on un-necessary crap that we have no time for the patient. And if you think it is going to get better, wait until you see the impact of the computerized medical record and computerized order entry systems. It takes thousands of hours to convert a hospital to a working system and participation at many levels is essential to do it right.
The second was the utilization of a robot by a NY hospital pharmacy to fill prescriptions. Intriguingly, it did so in 1/5th the time of a pharmacist allowing the pharmacist “to spend more time on patient care.” In my 40 years practicing medicine, I never witnessed a pharmacist offering patient care, but maybe that is coming. Everyone else seems to practice medicine these days; except the doctor who has trouble getting into the game. But as I thought about the article, I wondered why the robot did not take care of the patients. It does its thing 5 times as fast as the pharmacist.
Where is this impersonal system leading us? How many consent forms must I sign? What or where is the role for judgment? Will Accountable Care Organizations solve all our problems? Doubtful as the bigger the behemoth, the more impersonal it becomes. Medical homes? Sounds great to me. A group of dedicated doctors working hard to personalize care and keep it local to the practice and out of the hospital. Guess what? Non-physicians are forming them such as nurses and nurse practitioners. HMOs are sponsoring them as are other insurers. Hospitals, not wanted to lose money by fewer admissions, are buying medical practices to control the medical homes.
I trained in the 60s and started practicing medicine in 1970. In those years, 60% of the money was spent on hospital care, 30% went to physicians, and the rest to pharmacy and other services. Today, administrative costs of running an insurance company approach 25% of the total and that comes off the top. Special laboratory testing – CT scans, MRI studies, special cardiologic tests (catheterizations), g-I endoscopies and other special procedures eat up a huge amount of money. Hospitals are losing money and physicians are leaving programs like Medicare because they cannot cover their practice expenses anymore because of the steep discounting.
For those skeptics out there who still believe the health care system will take care of all their needs in the future, I wish you well. For the rest of you, start living healthier and do everything in your power to reduce you need for complex medical services.
Gerald L. Evans, M.D.
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