Complain Complain

It seems that not a day goes by without my coming across a comment or full article, written by a physician, about the horrid state of healthcare. American physicians seem to be particularly vocal about the [negative] changes  in the healthcare system over the last few years. Just before writing this blog, I read yet another piece on the status of physicians in the US. The author attempted to use sarcasm as a way of driving home her points. I personally found the article ineffective. But given that it was one of so many similar articles, I posted the following response. I purposely am not identifying the source of the article or the author to avoid any question of “Lashon Hara”.

“This is one of countless articles that relate to the present healthcare system in the United States as being from the worst I have ever heard of. From the tone of this article and many in the past, I assume that the medicine of old was superior because it allowed doctors to spend 30 to 40 minutes with each patient. Of course even a few decades ago, there was no CT or MRI or ultrasound or angiography or any of the advanced technologies that allow us to diagnose diseases that are also far better treated today than they were in the past. Despite the apparently horrid condition of American healthcare today, average lifespan is longer than it was a few decades ago. So somewhere, someone must be doing something right.

I assume that Dr. —– and all those who identify with her, appreciate that the time and effort spent in writing such articles and then commenting on them, plays directly into the hands of the (evil) decision-makers. Quite simply, when all you do is complain, there is in fact no pressure to effect change. Without an alternative plan that is financially viable, the decision-makers will continue to enact new protocols and even legislation which may very well further negatively impact healthcare. If the present system is so dysfunctional, then use these forums to come up with alternatives that provide better care without increasing health care costs. You all may need to invest in the assistance of economists, business experts, financial planners and the like. But your endpoint should be a plan which presents inescapable logic in terms of how to both better medical care and even reduce healthcare costs. Any elected official will immediately support such a plan and push for it in all venues that they can. If all doctors approach all of their representatives with such a plan, the likelihood that it will be enacted, is extremely high.

My humble suggestion is to use what little time you have at the end of the day to play the same game as the decision-makers, and to make arguments that they will reluctantly have to agree with.”

Medicine is far from the only field in which there are practitioners who feel that high-level decisions are incorrect. There is definitely a place for written comments in public forums in order to alert other practitioners and even the public as to  the existence of a serious problem. But change most often comes from action. In a world that is desperately trying to deal with periodic recessions and tighter and tighter budgets, the best solutions are ones that find a balance between quality and cost. Many doctors are very intelligent. If they were all to put their heads together, I have no doubt that they would come up with solutions that were relatively simple to implement and that would save costs almost immediately. I truly hope that such positive efforts will soon manifest.

One of the major pain points for many physicians is the way in which recording  medical data interferes with the natural flow of seeing a patient. Also, recording clinical information takes time. So if you add up all of the time spent in front of the computer by a physician, you will quickly discover that many more patients could have been seen during the same time. This does not mean that computerized medical records are a failure. What it means is that  EMR’s have to give back much more than they take. For example, if using an EMR makes writing a SAFE prescription much faster, that is time saved. If an EMR can retrieve old ECG’s and x-rays with a single click, this saves a tremendous amount of time going through old records or calling up other medical services for this information. Ultimately, if smarter and smarter EMR’s can predict the desires of the physician, then the physician will welcome the help.

Designing a whole new EMR is very difficult. What I suggest is for the entire physician population to reach for low lying fruit. Let every physician describe one issue that is particularly problematic when using EMRs. And the description has to be very specific. Simply saying that “I hate typing” is a valid complaint but would be more helpful if phrased as “my EMR requires too much typing to record a single diagnosis”.

Why is this kind of information valuable? Because either the major EMRs or start up companies will look at this information and build solutions to address these specific complaints. Doctors do not need to be programmers. But they can help programmers dramatically if they are very specific about what they don’t like and what they want instead. This sounds like something appropriate for Twitter – small focused comments about how to improve EMRs. My humble suggestion is that doctors around the world who use EMRs should embrace this.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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