Consider a few recent developments that have indelibly altered our medical practice. First has been the sudden emergence of a handful of powerful players in the field of electronic health records (EHRs), whose bloated software programs create enormous patient charts, resembling an auditor’s spreadsheets. Example: A nurse colleague recently demonstrated how it will now take her 11 mouse clicks to complete an order for a pneumococcal vaccine to be administered to a patient.
Second, clinicians have been astonished by the ascendant role of Medicare’s oxymoronic Meaningful Use parameters in determining what constitutes a useful clinical note. Although some requirements make sense and enhance the quality of care being rendered, others merely encourage more meaningless mouse clicking in an effort to achieve pointless targets.
Third, no doubt, will be the introduction in October of the bewilderingly confusing ICD-10 disease classification codes, which should have been coined, The Guide for the Perplexed, after the text written by the 12th century Jewish philosopher, Maimonides. Not surprisingly, this pedestrian system is woefully dated, having been developed nearly 30 years ago. Example: The seropositive status of patients with rheumatoid arthritis (RA) is determined solely by the presence of rheumatoid factor, because the cyclic citrullinated peptides hadn’t yet been described.
Fourth, and perhaps of greatest concern, medical care is being dispensed more and more by mega medical groups and hospital corporations. The steady decline of the solo and small group practice has reached a point of no return. The mantra has been that in order to survive as a clinician, one must belong to a huge organization with deep pockets and large and ever-expanding networks of referring doctors. How else could a practitioner negotiate with health insurers and regulators or be able to afford to install and maintain the costly information technology (IT) systems mandated by Medicare or survive an audit?
The Corporatization of Medicine
These changes have resulted in the science of medicine being replaced by the business of medicine (see Rheuminations, April 2015). Witness the intense business-speak used to advertise an upcoming medical symposium on healthcare hosted by the venerable New England Journal of Medicine: A new world. Competition. Consolidation. Integration. To drive improvement in quality and affordability, U.S. healthcare needs marketplaces driven by competition around real value for the health care consumer.3
A new world, indeed! Patients are now consumers or customers, medical specialties have become product lines or franchises and doctors are providers. Unwittingly, physicians are being transformed into readily interchangeable data-entry workers whose main task is to mouse click all the required buttons to get to the final screen where they can finally sign the record and move on to deal with the next customer. Our practices are beginning to look and sound more like call centers than centers of medical expertise. The precious and declining few minutes that constitute a visit nowadays are being further decimated by the need to engage in data entry or to correct the data entry work of others, because some of our colleagues have found ways to simply ignore the whole process.