I am an IT geek physician. I have my an EHR which I created and control.
Today, I wanted to understand my diabetic practice a little more, so I dumped all my HbA1c data out of my EHR and into a spreadsheet where I was able to manipulate the data and learn a few things about my practice.
I learned that:
If my patient had a HbA1c ≥ 8, the likelihood that the HbA1c would be < 8 at the next visit is 68%.
If my patient had a HbA1c ≥ 8, the likelihood the HbA1c would be even higher at the subsequent visit is 29%.
If my patient had a HbA1c ≥ 8, the average change in the HbA1c at the next visit was -0.7.
If my patient had a HbA1c < 8, the likelihood that HbA1c at the subsequent visit would exceed 8% would be 15%.
There are different ways to take the measure of a life. John Rockefeller, the richest person in the history of mankind, once asked a neighbor, “Do you know the only thing that gives me pleasure? It’s to see my dividends come in.” Television magnate Ted Turner once said, “I don’t want my tombstone to read, ‘He never owned a network.’” And musical artist Lady Gaga has described her quest as “mastering the art of fame.” But wealth, power, and fame are not life’s only metrics, and September 4 marks the 50th anniversary of the death of one of the 20th century’s brightest counterexamples.
His name was Albert Schweitzer. Winston Churchill once referred to him as a “genius of humanity,” and a 1947 issue of Time magazine dubbed him “the greatest man in the world.” Though Schweitzer held four doctorates and achieved worldwide fame as a musician, theologian, medical missionary, and promoter of a philosophy of “reverence for life,” for which he received the 1952 Nobel Peace Prize, his most enduring contribution lies in his lifelong commitment — both theoretical and practical – to the suffering.
Schweitzer was born 1865 in the Alsace region of what is now eastern France, the son of a Lutheran pastor whose grandfathers were both accomplished organists. Though already a world-renowned musician and writer, at age 30 Schweitzer decided to answer a call to missionary work, spending the next seven years of his life studying medicine. Once he finished his medical studies, he and his new wife, Helene, traveled 4,000 miles to set up a missionary hospital in what is now Gabon in west central Africa. There he spent most of the rest of his life, eventually dying there in 1965.
In the midst of sluggish economic growth, finding a sector of the economy growing from 15 percent of the economy up to 19 percent would normally be a cause of celebration, except that this is health care. The lack of good cheer about this growth is an indirect acknowledgement of a stark reality: We are not realizing much increased value as we spend more on health care because too much of our health dollars are going to ineffective (and often harmful) procedures.
Estimates of the waste from this overconsumption of health care range from 30 percent to 50 percent. While all of the experts talk about reducing this waste (the phrase of the day is “bending the cost curve”), the reality is that hospital administrators, pharmaceutical companies, device manufacturers, insurers, consultants, think tanks and government bureaucrats all are seeing their power, control and financial remuneration increase due to this medical-care consumption growth.
All of the reformers’ trendy ideas have failed and will likely continue to fail in spite of the experts telling us they will soon figure it out. Electronic health records are a hugely expensive disaster. So far, they decrease doctor efficiency, reduce quality and increasingly make patients fearful of sharing sensitive information with their doctors for fear hackers or others will access their private data. Accountable Care Organizations turn doctors into rationers, introducing a conflict of interest between doctor and patient. Price controls by Congress or bureaucrats or oligarchic insurers only reduce access to care, demoralize doctors and introduce the risk of game playing by health systems by “up-coding” (labeling a doctor visit as more complex than it is).
In my work with hundreds of over stressed and burned out physicians, one thing is constant. Documentation is always one of their biggest sources of stress.
In fact, if you ask the average working doctor to make a list of their top five stresses, documentation chores will take up three of the five slots.
1. EMR – especially if you use multiple EMR software programs that don’t talk to each other
2. Dealing with lab reports and refill requests
3. Returning patient and consultant calls and documenting them adequately and all the other places information streams have to be forced together by the sweat of your brow.
The average doc is walking the cliff edge of overload on a significant number of office days in any given month. Now comes ICD-10 and my biggest fear is the extra work of the new coding system will push many physicians over the edge into burnout.
This is the fourth in a never ending series of screeds that attempts to crack open words that are misused, misguided misnomers in the healthcare arena.
“Provider” is a substantial, material word that will require a medical sledgehammer to crack open…and what we find inside this 8-letter facade will turn your stomach and give a new sense of appreciation for it’s history.
First, before the healthcare system adopted and mangled this well-meaning word, it was not a healthcare word. It had real meaning rooted in family life; the head of a household provided for their family. It was rooted in substance and survival. There was an aura of pride and dedication in being that family
Sadly, healthcare has an clumsy tendency to mangle and maim its lexicon….and has rendered provider a hollow noun, a shell of its former self.
As physicians and clinicians we provide a service to people who are sick, worried or dying….as we have since the days of shamans, medical men and healers. So, why and how did the word provider rise so rapidly? If you look at any historical literature or descriptions of healthcare, there are sparse references to medical professionals as providers.