Blogfinger

Click on the Times article below to read:

By Paul Goldfinger, MD, FACC

The key words in this NY Times article are:  “a failing healthcare system.” The authors, a doctor and a nurse, speak of a “non-system” and a “pernicious problem.”  They say that doctors and nurses are near to the “breaking point” and that suicides are rising in these professions.

Part of the problem is the increased work load due mostly to failing electronic health records which reflect demands for “over-documentation” by insurance companies and hospital corporate systems.  I encourage you all to read this piece.

We have been commenting about healthcare quality concerns in a series of Blogfinger posts since 2013 and we have stressed the deterioration in quality despite impressive technological advances.

In Nov, 2018, I wrote a piece on this subject, and here is part of that post:

—-Electronic medical records are improving, but they don’t live up to the promise so far.

—-Communication between doctors has deteriorated.  Electronic check lists are passed around, but not enough person-to-person conversations are occurring, even as healthcare continues to become more complex.  Checklists and duplicated commands replace individualized conversations and chart notes.  Important facts fall between the cracks.

—-It is more and more difficult for patients to speak to physicians.  Instead the patient or family is forced to talk to a MLP  (mid-level provider)  such as a medical assistant, a phone answerer or a physician assistant, and the physician may  be cut out of the loop altogether; and some critical medical concerns may be missed or erroneous.  These problems are found to be common in medical offices, urgicenters, and even highly regarded hospitals such as Meridian Jersey Shore.

—Medical offices and facilities such as hospitals are more likely to be run by corporate efficiency experts who may not even discuss practice procedures with physicians who know best what quality care requires, but those doctors may be powerless employees. This results in physician cynicism, frustration, depression, burn-out, and early retirement.

——There are too many routine office visits and routine tests done.  It seems like every doctor has some sort of shtick (ie procedure or excuse for an office visit) which may not be necessary. It often looks like churning to make up for declining reimbursements.  One specialist told me that his group is requiring that he conduct 10 minute office visits—outrageous and doomed to harm patients!  Healthcare professionals are often required to behave in ways that will create higher reimbursements.

For example, Medicare patients who are doing well must return for office visits but now, in addition, there are prevention visits to go over information that could be taken care of at a routine OV.   If Medicare weren’t paying for these special visits, they would not be deemed essential.

I love Dr. McAneny’s quote,  “The healthcare system often gets in the way of actual healthcare.”  This a very insightful remark, and we all need to remember what she said, and keep our eyes open.

As I physician and as a patient, I have witnessed examples of deteriorating inattentive care for myself, family and friends.  When I go into a healthcare facility I often notice practices that are worrisome, such as carelessness in taking blood pressures and failure to discuss the list of medicines which one just struggled to fill out.

And I wonder who is looking after the big picture for each patient in an environment where every worker falls into some isolated niche.  Most patients now need medical advocates to watch over their care.

I plan to post examples of worrisome care which I have witnessed and I will welcome examples from our readers, but only when such tales make a point about current care and only when the story is brief.