I tell my patients there are three types of science: 1) investigative science, which sometimes gets it right; 2) science in the courtroom, which is junk science; and 3) science in Washington, D.C., which is political science.
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Explore This IssueApril 2016
Our decisions are based on art and science; our patients’ medications are brought to market based on science. And yet the way we are now extorted to treat and mandated to care for our patients is not based on any science. It is political science.
We need to make medicine great again. What’s happening? Here are a few examples:
We write an FDA-approved medication prescription for our patient for a specific medical condition, and then we are told by the patient’s insurance company that we cannot use that medication; we need to use another FDA-approved medication in the compendium, which does not have an FDA label indication for the medical condition we want to use it for. This medication is not what we want to use, but if we don’t, we cannot treat our patient. Then they turn the tables around when we want to use an FDA-approved medication supported by literature to work for a condition not listed on the approved label, and they decline it based on the package insert—right drug, wrong disease.
In these examples, science does not trump politics or economics. This practice is executed by insurance companies and is called non-medical switching. It’s not based on medical science, but on insurance pseudo-science.
Electronic Medical Records
I think electronic medical records (EMRs) have great promise.1 I began using one program, QD, in 1998 for that reason. Slowly, it was integrated into my care, and we have used it full time since 2008. QD was developed by physicians, including rheumatologists, for physicians. It is still great and gives me the ability to personally change the program on the fly at any time to help the care of the patient. (Note: You can’t do that with the big guys, where program changes need to be implemented centrally and take a long time.) But the typical EMR picture is one of a physician typing on the computer with his back turned to the patient.
Thus, the computer is imposed and now takes precedence in the doctor–patient relationship. The AMA white paper on the inefficiencies of EMRs emphasizes that they are time consuming and prolong patient visits.2 Only an approved EMR allows one to qualify for Meaningful Use, but EMRs have not truly shown a benefit in patient care or reduction in cost of care. Hopefully, the assistance of the AMA and its presence on this issue will help us in this setting. Edward J. Schloss, MD, writes that healthcare documentation is performed for three reasons:3 1) Healthcare delivery (that’s the obvious one); 2) Regulatory compliance (checking all the boxes our government and payers think are important); and 3) Malpractice avoidance (no one wants to get sued).