The Power Went Out

I decided years ago I wouldn't adopt an EHR. Yes, I use paper charts, with my own hand drawings for the purposes of illustrating TO MYSELF AND THE PATIENT where the suspicious lesions are geographically on their bodies. The lack, of and often nonsensical, governmental communications regarding HIPAA policy on storing, managing and receiving sensitive patient data electronically stopped me. I also practice on an island. Some may think it's paradise. But paradise doesn't come with buried electrical cables, and every tiny windstorm, thunderstorm, or power surge causes our power to go out, and it's always at 10am, in the heat of clinic. I cannot function without electricity, so I close for the day. I can still think, and write by a window for light, just like in the time of Adams. But I can't click away. God bless my colleagues who try. This is why they're quitting and leaving a shrinking pool of doctors or clinics who can accept new patients. The lack of control and endless frustrations with simple infrastructure is driving physicians out of the field entirely.

But I digress.

I searched a bit online, just for fun, about the whole flurry of excitement circa 2008 on EHR. It seems everyone was pushing for EHR implementation, and right quick, with no thought or consideration. Epic is the largest and the most profitable software vendor, contracted to Kaiser Permanente, Mayo Clinic, and lots of other illustrious medical centers. It's got to be good, right? With the imprimatur of world class institutions as clients, and a little old fashioned bribery, it took off.

Here's some interesting reading about the history/origins of Epic--click here.

Here's Michelle Malkin's (love her) pitbull terrier assessment from 2013: click here.

It gets better--she researched that Epic has the lock on EHR for the Dept. of Defense and the Pentagon. The health records of the military. The cake was big, and everyone had a slice at the party: click here.

These weak systems are being hacked for ransom by cybercriminals. A hospital in LA got hacked and held ransom for 17K in Bitcoins--smart financial move with the weak dollar. AND THE HOSPITAL PAID IT AND GOT THEIR RECORDS BACK. We are not privy to the information on where are the hackers, who are the hackers, are they in Ukraine? Panama? Peoria? This info isn't for the plebs. Nothing to see here, keep moving.

Who hasn't gotten a letter that their health information was hacked? I got one from the center where I got X-rays,  and my patients regularly get them from other doctors and hospitals and they ask me about it. I tell them that since I don't use EHR's, there is 100% chance that my records won't be hacked. I tell them we're all pawns in the machine. They get unhappy when I say this, like the kid yelling in the playground that there's no Santa Claus. Sorry folks, reality is where I live, wake up and smell it.

Now I see commercials from IBM touting Watson and the supercomputer that beat Jeopardy! It will one day be our collective physician. Look, physicians use it to supercompute through patient data! And the data show the patient had his seatbelt on and the shingles/pneumovax/flu shot!!

Can Watson evaluate the fingernails of a patient with factitial dermatitis, just like Sherlock's sidekick used to do --NO (literary fiction folks, Sherlock Holmes was not real--this is for the Millenials, the group we love to hate). Can Watson smell the alcohol on the breath of the limping white haired man with a total body skin rash for years? No.

Don't tell me it will take my place.

Care, But No Care

It never ceases to amaze me how much "care, but no care" I see from patients who come in with horrific skin conditions. They've been to 3-7 "doctors"--in reality, 3-7 nursing assistants or nurse practitioners supposedly working under the wing of a physician--this is never the case. They're confused and can't tell me what they have been told, diagnosed with, much less prescribed. They certainly got asked about their flu shot, seat belt, sunscreen usage, etc. heck a skin cancer screening was done!-- but the core issue they came in to get treatment for fell by the wayside. They have very extensive and severe dermatological conditions which require deep and thorough evaluations and work-ups. I request medical records. Sometimes I get them. More often I don't, and I have to start from scratch. It's easy to "start" because literally, nothing has been done. Patients look at me with eyes wide as saucers when I tell them I'm going to need to take a skin biopsy. I think they imagine a sledgehammer or cleaver behind the closet door to take the skin biopsy, and they're beyond shocked at how simple and quick it is for a SKILLED physician to do. No infections or extraneous bleeding all over the floor. Dermatologists do it clean. Would you ask the plumber to fix the oven? No.

I tell them this will be a process and that together, we will find a way to treat their skin problem. They tell me they were told "to put Vaseline on it".
EYEROLL.

Why is this happening? How did this happen?

My assessment: it's not heath care, or medical care, any longer. It's patch and turf, get the data into the EHR, collect the bonus. Punch the clock. Kick the can down the street. I'm tired and I want to go home.

This is deeply concerning and destructive. Doctors are quitting medicine altogether in droves. With no representation and no power "at the stakeholders' table", it has been widely documented that doctors nearing retirement have accelerated the process, and increasingly doctors in their prime are quitting medicine altogether. The AMA has long stopped representing physicians. It is a bewildered anachronism with a core mission to "improve the health of the Nation"--a big mission, nothing about protecting the doctor. I know of many who have quit lucrative medical careers and started yoga studios, vegan food services, medi-spas, health coach. Doctors are smart self-starters. They get tortured with EMR's, ICD 10, ACO (administrative) nurses with clipboards tallying the counts on the PQRS measure, and endless documentation bullshit. For doctors, money isn't the issue. It's about ownership of your skills and TIME. So they quit medicine forever. The tunnel narrowed and for these doctors, it was time to jump ship for sheer survival.

The latest most dangerous game: please the patient above all else so they give the clinic/hospital/staff 5 stars on Healthgrades or Yelp surveys. This includes the handing out of narcotics, to keep the masses comfortably numb and more apt to give a favorable online review. This is happening.

This isn't flying a plane. This isn't assembly of Toyota cars. This isn't an ATM transaction (although many would beg to differ). This is down and dirty, elbows-up-to-the-guts REAL LIFE. We witness birth and death. Pain, infections, cancers. Broken bones and broken hearts. Every human ailment, whether physical, mental, genetic, environmental. Populations don't get sick. Individuals get sick, and us humans are as infinitely different and crafted as nothing else in our world. We have free will. We can choose to take the pill, or not. To smoke, or not. And so doctors or clinics cannot be held accountable when the smoker gets readmitted for pneumonia while smoking 2 packs per day. Are clinic staff to go home with the patient,  following them around and being like a prison warden, cutting off the cigarette supply? Only 25% of ACO's have turned a bonus. That means 75% haven't earned a penny in "incentives for coordinating and streamlining duplicative care and producing efficient quality care". I suspect what's actually happening is a lot of hand waving and boxes being clicked, but no substantive results on anything. Florida Medical Association put together a concise article with startling statistics.

http://flmedical.uberflip.com/h/i/233300395-florida-medical-association-magazine-spring-2016

This is a giant waste. The maw of this monster must be stabbed, like St George slew the dragon. Doctors must regain the courage to say NO. I will not click the box. I will not see 78 patients in 6 hours. I will not work for free. Weekends belong to me now. I will not do a preauthorization, iPledge, online data entry, "in between patients". We must start saying no and we must start pushing back. Many already have. I'm just afraid that when it comes time for ME to have medical care, I will be turfed to the system that punches the card, in and out.

Thank you Government. Thank You Corporate. You've made lovely bedfellows. It's time to burn the bed.