Moving On – NJEM Perspective

Posted by timmreardon on 05/21/2018
Posted in: Uncategorized. Leave a comment

May 10, 2018
N Engl J Med 2018; 378:1763-1765
DOI: 10.1056/NEJMp1801485

Abigail Zuger, M.D.

eryone in my examining room is aging on schedule, patients and doctor alike. It’s quite a change from the scene a few decades ago, when all of us were young and the patients were dying, one HIV-fueled departure after another, each one surrounded by a little medical care to soothe the worst of it.

Now I’m the one contemplating a permanent departure. My health is fine, but my stamina is pretty much gone. Our health care system is not kind to the chronically ill and marginally insured, and it is not particularly kind to their doctors, either. Our patients are condemned to an unending swim against a hostile tide. Doctors can head for shore.

Taped to my wall is a list of cutting-edge HIV drug combinations: their perplexing brand names refuse to adhere to my feeble old neurons. I clearly remember the drugs we no longer use but cannot retain the ones we do. The day I pasted up that list, I knew my time was nigh. Surely my patients deserve a cheerful young M.D., version 2.0.0, to bear them upstream for their final miles with energy and brio, unencumbered by sentiment, cynicism, or useless memories.

The stroke of the axe between patient and doctor is not a unique separation, no more inevitable than graduation, no more final than divorce. But divorce at least brings relief to two warring parties, and graduation celebrates the arrival of the new as much as the departure of the old. When a doctor says “enough,” that’s it. There will be no family reunions or tentative rapprochements between me and my patients, no alumni weekends. No matter how tight we are now, should we meet again we will be polite former acquaintances.

I will lose dozens of very old friends, and quantities of power and influence. No more license to ask rude personal questions, to issue edicts and stride away. No more urging poisons on those who would rather avoid them (“Oh, just try it for a week”) or withholding poisons from those who crave more (“No more Percocet for you!”).

And what will my patients lose? Theoretically, not too much. All our guidelines and algorithms, herding us to march in lockstep, are intended to guarantee just that. When one soldier in the line crumples, another steps right in and the professional formation moves on. The quality metrics of my patients’ health care should only improve when I go, assuming the new soldier thinks a little more highly of some of those guidelines than I do.

And the memories of my patients’ decades of life with a dire disease will become theirs alone. Their old paper medical records are off in storage now, and their digital charts are full of inane computer-speak, cut and pasted into gibberish. Here’s one mandate that’s not part of any guideline: understand the patient’s past before the two of you waltz off into the future. But now the past is accessible only with a call to a warehouse and a long wait. Though many patients, given the time and encouragement, will eagerly talk about their long journey from sick to well, a 20-minute appointment slot allows for neither.

One Friday morning, my 10:40 is a tall, handsome, overweight guy who just turned 40. We first met in 1995, but I haven’t seen him for almost 2 years: he changed jobs, endured a long hiatus without insurance and, I assume, curled back into himself like a frightened animal, waiting for the apocalypse. I remember that he spent his early 20s in exactly such a state. He was quite thin back then and always dressed entirely in white (“My shroud,” he would say) in expectation of the inevitable.

The inevitable never came for this one; we finally found a set of HIV drugs his nervous stomach could tolerate, and his labs recovered. He himself never did recover, although he married, bought a house, got a series of good jobs. Now he smiles at me (“How gray he’s gotten,” I think) and shrugs. “I keep wondering,” he says. “Is this all there is?” Depression leaks from his pores. He is as post-traumatic as any wounded warrior, as stressed, as disordered. Will his new doctor dismiss him as just one more entitled GenX-er? Could he even muster the stamina to describe the years he spent enshrouded?

My 11:20 doesn’t show up — or, rather, he doesn’t show up until a little before noon, when there is a small kerfuffle at the front desk, the slam of a hand on a counter, a whirl out the door. He was told he can’t be seen during lunch, and he is angry, even angrier than usual. This patient also survived a perilous postadolescent brush with illness, and many slammed hands on many counters are one result. He has told me at length how much he hates it all: the pills, the appointments, the blood tests, even little old me. And yet he never skips a dose or a vaccination or a visit; his discipline is extraordinary, his rage terrifying. He is my own personal tiger, and I am not entirely unhappy to hand him over to a new keeper. How will he fare?

My 1 p.m. is also missing in action, but then I hear her opening lines, and she rushes into the room: “Sweetheart! The traffic!” She is always late, always in a hurry, apologetic and worried about my commitments to other patients.

“My love! I know you’re busy. I’ll be quick. I just need my prescription, and I won’t keep you. Oh, look at you! Look at you! Love, love, love the shoes!”

We are of an age, she and I. Even so, the moment she shows up, I am transported back in time: I am a terrified young doctor again, all alone in unmapped medical terrain, charged with healing a skeleton.

My patient’s hair is moth-eaten cotton batting, her frame all bone, the skin on her face has darkened and mottled, her eyelashes are long behind bottle-thick lenses. A historical relic, she belongs in an AIDS museum, not my exam room.

She has never, ever taken her HIV meds. I have scoured her old charts and emerged without answers. She doesn’t appear to be selling the pills. She dabbles in heroin, cocaine, and methadone but otherwise lives an ordinary middle-class life. Over the years, other doctors issued all the usual ultimatums. She shrugged them off, and survived, even thrived. Her blood tests screamed disaster, her health remained fine. Now she’s impervious to all reprimand and warning. Can anyone blame her for concluding that she’s immortal?

But the virus is clearly catching up with her, sapping her energy and appetite. She still talks a good game, but she looks like a walking corpse.

She is the toughest nut I’ve ever tried to crack, and instead — predictably enough, I suppose — she has cracked me. I cannot stand to see her die, not on my watch, not in this century, and so I have struck a very dubious bargain with her. Call me Dr. Faustus. If she takes her meds, I told her a few months ago, I will stop tapering the gigantic daily doses of Percocet another provider gave her, and leave her on a small amount. Percocet is the only prescription drug she really respects.

My project is working beautifully. She still looks like hell, but she has gained 10 pounds, her blood tests have turned around dramatically, and her increased vigor is apparent.

Whatever will happen to her, my big worry and secret pride, my last great resurrection? What will happen to every last one of them? Someday soon I will lose the right to know.

When I close the door to my airless little clinic room for the last time, I will be closing hundreds of charts in the middle and walking away before the stories end. In all of medicine, is there anything more difficult to do than that?

Disclosure forms provided by the author are available at NEJM.org.

Article link: https://www.nejm.org/doi/full/10.1056/NEJMp1801485

Author Affiliations

From the Mount Sinai Health System, New York.

Supplementary Material

Disclosure Forms PDF 83KB

Making Health Care Work Better for Vulnerable Patients – Commonwealth Fund

Posted by timmreardon on 05/21/2018
Posted in: Uncategorized. Leave a comment

Q&A with Pamela Riley, M.D., M.P.H.

Friday, April 27, 2018
By The Commonwealth Fund

Commonwealth1xSince 2013, the Commonwealth Fund’s Health Care Delivery System Reform program has focused on ways to improve health care and outcomes for two populations: high-need, high-cost patients (including frail elders, the disabled, and those with multiple chronic conditions) and vulnerable populations, or those with low incomes. We spoke with Pamela Riley, M.D., M.P.H., who directs the portfolio of grants focusing on vulnerable populations, about her program strategy and what she’s accomplished so far.

Why focus on vulnerable, or low-income, populations?

Pamela Riley: For all of its 100 years, the Commonwealth Fund has been committed to improving health care for vulnerable populations, including women, children, and rural Americans. My work focuses on people with low incomes, who are disproportionately racial and ethnic minorities. Because they are less likely to have health coverage, they may have little interaction with the health care system. They are less likely to receive recommended preventive care, including dental care, blood pressure checks, cancer screenings, and flu vaccinations, and more likely to wind up in the emergency department or hospital for a condition that might have been treated elsewhere. They are also twice as likely as those with higher incomes to have behavioral health problems, three times as likely to be socially isolated (which we know can have implications for health), and 10 times more likely to experience food insecurity.

How is the health system failing vulnerable Americans?

Pamela Riley: Providers serving vulnerable patients struggle to engage patients in their care and meet their physical, behavioral health, and other needs. We’ve funded research investigating whether Medicaid accountable care organizations (ACOs) could help coordinate physical, behavioral, and dental services for vulnerable populations. We’ve supported the Center for Health Care Strategies to develop resources for states interested in promoting Medicaid ACOs.

We also know that the health system can do much more to address behavioral health problems such as addiction and depression that often go undetected and untreated among vulnerable populations. Because health plans are now required to cover behavioral health services, there is real opportunity to focus on how to maximize those benefits. We’ve supported research identifying quality measures to assess the level of physical and behavioral health care integration, and illustrating the potential of the Medicaid programs to drive such integration.

What can health care providers do to help people who don’t always have nutritious food or stable housing?

Pamela Riley: It’s not news to most health care professionals that if their patients’ basic needs aren’t met, they’re not likely to stay healthy, no matter how good their care. But many providers don’t know how to help. Over the past several years we’ve supported the nonprofit organization Health Leads to create a road map for providers as they work to identify patients’ social needs and connect them to resources. We’ve funded research exploring how health care organizations can address patients’ social needs in a financially sustainable way. And we’ve also engaged Manatt Health researchers to study ways to use Medicaid managed care funding to support nonmedical interventions, like helping people find jobs.

Medicaid is clearly a key player: what have you learned about the potential of state Medicaid programs to promote improvements in care for vulnerable populations?

Pamela Riley: As the largest payer, Medicaid has a lot of leverage. We’ve supported research to look at ways in which Medicaid can promote better value as health care purchaser. Are there, for example, alternative payment models that might work in federally qualified health clinics, which are generally given prospective payments and may need incentives to move toward value?

We’ve also looked at how Medicaid managed care plans, which provide care for more than half of beneficiaries, might help improve care for vulnerable populations (including a look at strategies in 10 states that expanded Medicaid, managed care regulations that encourage integration of behavioral health care, and ways that managed care plans are addressing social needs).

What else is needed to engage more low-income patients in their care and ensure it meets their needs?

Pamela Riley: Improving primary care is probably the most important thing we can do in terms of health services to improve the health of vulnerable populations, and the Commonwealth Fund is just starting to look for models of how to do this. We know that primary care clinicians feel largely underprepared to meet the behavioral health and social needs of their low-income patients. So we need to find ways to support practices in their efforts to partner with community-based organizations, for example, or incorporate members of the community on their teams, to meet patients’ comprehensive needs.

We also know health care is often inconvenient or inaccessible to low-income patients, who may lack paid time off work or transportation to visit the doctor, leading many to rely on the emergency department. We need to think about ways to bring the tools of concierge medicine — telehealth visits, 24/7 access — to these populations as an alternative to high-cost settings of care.

While we do this, we have to be careful not to put too much on the back of primary care providers. Finding ways to effectively partner with community-based organizations is critical to reducing the burden on primary care providers. As more and more states are turning to managed care plans to deliver care for their Medicaid beneficiaries, we’ll be tracking how plans can support primary care providers as they work to improve care for low-income patients.

Article link: http://www.commonwealthfund.org/publications/blog/2018/apr/making-health-care-work-better-for-vulnerable-patients

As D.I.Y. Gene Editing Gains Popularity, ‘Someone Is Going to Get Hurt’ – NYT

Posted by timmreardon on 05/21/2018
Posted in: Uncategorized. Leave a comment

After a virus was created from mail-order DNA, scientists are sounding the alarm about the genetic tinkering carried out in garages and living rooms.

NYTy

Across the country, biohackers — hobbyists, amateur geneticists, students and enthusiasts — are practicing gene editing, concerning some bioterrorism experts.CreditRyan Christopher Jones for The New York Times

By Emily Baumgaertner

WASHINGTON — As a teenager, Keoni Gandall already was operating a cutting-edge research laboratory in his bedroom in Huntington Beach, Calif. While his friends were buying video games, he acquired more than a dozen pieces of equipment — a transilluminator, a centrifuge, two thermocyclers — in pursuit of a hobby that once was the province of white-coated Ph.D.’s in institutional labs.

“I just wanted to clone DNA using my automated lab robot and feasibly make full genomes at home,” he said.

Mr. Gandall was far from alone. In the past few years, so-called biohackers across the country have taken gene editing into their own hands. As the equipment becomes cheaper and the expertise in gene-editing techniques, mostly Crispr-Cas9, more widely shared, citizen-scientists are attempting to re-engineer DNA in surprising ways.

Until now, the work has amounted to little more than D.I.Y. misfires. A year ago, a biohacker famously injected himself at a conference with modified DNA that he hoped would make him more muscular. (It did not.)

Read full article

 

 

First-ever WHO list of essential diagnostic tests to improve diagnosis and treatment – World Health Organization

Posted by timmreardon on 05/18/2018
Posted in: Uncategorized. Leave a comment

Today, many people are unable to get tested for diseases because they cannot access diagnostic services. Many are incorrectly diagnosed. As a result, they do not receive the treatment they need and, in some cases, may receive the wrong treatment.

To address this gap, WHO has published its first Essential Diagnostics List, a catalogue of 113 tests needed to diagnose the most common conditions as well as a number of priority diseases.

Read Press Release

EDL_ExecutiveSummary_15may

WHOy

VA Signs $10 Billion Health Records Contract With Cerner – Nextgov

Posted by timmreardon on 05/18/2018
Posted in: Uncategorized. Leave a comment

VA will formally pursue the same health records platform as the Pentagon.

The Veterans Affairs Department inked a 10-year, $10 billion contract Thursday with Cerner Corp. to adopt the same commercial electronic health records system as the Pentagon.

Veterans Affairs Acting Secretary Robert Wilkie in a statement said VA’s future health records system will seamlessly communicate and exchange records with the Pentagon’s, resolving an issue that cost the agencies billions in recent years.

“President Trump has made very clear to me that he wants this contract to do right by both Veterans and taxpayers, and I can say now without a doubt that it does,” Wilkie said. “Signing this contract today is an enormous win for our nation’s veterans. It puts in place a modern IT system that will support the best possible health care for decades to come. That’s exactly what our nation’s heroes deserve.”

The contract with Cerner was announced last year by then-Veterans Affairs Secretary David Shulkin, but several issues, including congressional funding and Shulkin’s eventual firing, slowed the contract’s final signing.

According to Wilkie, the Cerner contract will allow the agencies to share patient data among Veterans Affairs, the Defense Department and community providers “through a secure system.” Combined, the two agencies have more than 20 million beneficiaries, including soldiers and veterans.

“Health information will be much easier to share, and health care will be much easier to coordinate and deliver, as well as faster and safer,” Wilkie said.

The department received nearly $800 million in funding from Congress for fiscal 2018 to begin the contract.

“We’re honored to have the opportunity to improve the health care experience for our nation’s veterans. The VA has a long history of pioneering health care technology innovation, and we look forward to helping deliver high-quality outcomes across the continuum of care,” said Cerner President Zane Burke, in a statement.

Meanwhile, the Defense Department is rolling out MHS Genesis, also developed by Cerner Corp., at four locations, but the pilot keeps hitting problems. That contract is worth up to $9 billion. Work temporarily stopped in February to address more than 14,000 help-desk tickets, many of which involved workflow changes. Pentagon testing and evaluation officials last week declared the system “neither operationally effective nor operationally suitable” after testing three of the four facilities.

Testing officials determined users could only about half the 197 tasks used as performance measures, and experienced latency issues and outages as more logged on. They concluded the end-to-end system couldn’t support the capacity of the four test sites even though the department expects to support 9.6 million beneficiaries from hundreds of facilities.

Defense officials said they will learn from the platform’s initial failures, and they’ll be working hand in hand with Veterans Affairs officials as the agency works to implement the same health records platform.

“VA and DoD are collaborating closely to ensure lessons learned at DoD sites will be implemented in future deployments at DoD as well as VA. We appreciate the DoD’s willingness to share its experiences implementing its electronic health record,” Wilkie said.

Article link: https://www.nextgov.com/it-modernization/2018/05/va-signs-10-billion-health-records-contract-cerner/148300/

Pentagon’s EHR Setbacks ‘Don’t Bode Well’ for Potential Veterans Affairs Rollout – Nextgov

Posted by timmreardon on 05/16/2018
Posted in: Uncategorized. Leave a comment
By Jack Corrigan,
Staff Correspondent

The Veterans Affairs Department will be looking to avoid mistakes made thus far by the Pentagon.

The Pentagon is facing major setbacks in the rollout of its new electronic health records platform, and that dampens the outlook for the Veterans Affairs Department as it prepares to implement the same system, said the agency’s former leading technologist.

The Defense Department reported Friday the MHS Genesis system it’s spending $4.3 billion to develop “is neither operationally effective nor operationally suitable.” Initial field tests at three facilities were so bad the agency decided to cancel the testing at a fourth location and delay further pilots until it can address the numerous flaws it uncovered.

As the VA finalizes a contract potentially worth $16 billion with Cerner Corp. to put the agency’s 9 million beneficiaries on the same Genesis platform, former chief information officer Roger Baker told Nextgov the agency should prepare to face the same problems—if not more of them.

“It’s no surprise that a program as big as MHS Genesis…is going to have problems like this—according to all the metrics, most large federal IT programs aren’t successful,” said Baker, who held the department’s top tech job from 2009 to 2013. “[VA] need[s] to remember that the probability they’re flushing that $16 billion down the toilet is actually greater than 50 percent.”

But beyond the general challenges inherent in massive IT projects, VA faces an even steeper uphill battle implementing a new system than the Pentagon, Baker said.

For one, most VA doctors don’t mind the current platform. The VA’s electronic health system was rated the best for overall user satisfaction in a survey of more than 15,000 physicians, while the Pentagon’s current platform–the Armed Forces Health Longitudinal Technology Application–scored dead last. “What’s it going to look like when VA is trying to replace the most liked [platform] out there?” Baker said, especially when the military is having trouble convincing doctors to quit one of the least liked.

He also noted that unlike military physicians who are required to follow orders in a rigid command and control hierarchy, VA doctors can push back harder against system changes they don’t agree with.

“You can tell them what you want them to do, but they put patient care far above anything else, and they will tell you where to stick it if they think you’re impacting patient care,” he said.

That environment may not bode well for VA leaders looking to implement a system that during field tests reportedly experienced 156 incidents which could have led to patient deaths, according to Politico.

House Veterans’ Affairs Committee Chairman Phil Roe, R-Tenn., has asked to meet with the agency’s leaders “in light of [the Pentagon report’s] troubling findings,” his communications director Tiffany Haverly told Nextgov.

Baker said VA might be even less equipped to lead a project of this size given the recent shakeups in agency leadership.

Staying focused on the final product and having “the wherewithal to say ‘no’” to anything that doesn’t serve that end is “the most critical” factor in the success of a large scale IT program, he said. And after former Secretary David Shulkin’s ouster, Baker doesn’t see anyone at the VA willing to take that stand.

“In making the decision to go to the new EHR, [Shulkin] demonstrated that he was willing to make very tough decisions whether people liked them or not,” Baker said. “Without that, the probability of success with any large IT program…is almost nil.”

He still finds it highly unlikely the Pentagon’s test results will unravel the Cerner deal, which VA Chief Financial Officer Jon Rychalski told Congress is scheduled to be signed May 28.

“I think VA’s too far down the road at this point,” Baker said.

To mitigate the chances the agency repeats the Pentagon’s failures, he suggested VA pilot Genesis at a single facility and work out the kinks before scaling to a larger rollout.

Article link: https://www.nextgov.com/cio-briefing/2018/05/pentagons-ehr-setbacks-dont-bode-well-potential-veterans-affairs-rollout/148200/

Initial Tests Find Defense Department’s MHS Genesis ‘Not Operationally Suitable’ – Nextgov

Posted by timmreardon on 05/14/2018
Posted in: Uncategorized. Leave a comment

NextgovxThe test director recommends delaying further fieldings.

The rollout of the Defense Department’s next-generation electronic health records system is not going smoothly.

Field tests of the Defense Department’s electronic health system at three locations went so poorly the testing agency scrapped plans to test at a fourth facility, according to a report released Friday.

Those three tests were enough to determine that “MHS GENESIS is neither operationally effective nor operationally suitable,” wrote Robert Behler, the department’s director of operational test and evaluation, in a letter dated April 30. In the letter, Behler recommended the department delay rolling the system out at other locations until his agency is able to complete its testing and the program manager fixes all the deficiencies they’ve found.

“While we still have challenges to come, we are clearly making significant progress. We continue to be and have been open and transparent,” Stacy Cummings, program executive officer for Defense Healthcare Management Systems told reporters Friday.

MHS Genesis is being developed by Cerner Corp. and systems integrator Leidos, which captured a $4.3 billion contract to build the next-generation health records system in 2015. Rollout of the system, which is eventually supposed to serve 9.6 million beneficiaries, was halted temporarily in February after it generated some 14,000 help tickets. Those issues are among several that have not been alleviated, according to Defense officials.

The initial test report found the system doesn’t demonstrate “enough workable functionality,” with users only able to perform 56 percent of the 197 tasks used as performance measures.

The list of flaws is long, including:

  • Poorly defined user workflows.
  • Increased time for health care providers to complete tasks, in some cases leading them to work overtime or see fewer patients per day.
  • Inadequate training.
  • Inadequate help desk support.
  • Inaccurate patient medical data.
  • Excessive system latency.
  • System outages.

The latency issues and outages indicate the end-to-end system and supporting network couldn’t support the users at the four tests sites, let alone the hundreds of sites the department eventually plans to add, according to the report.

In a statement issued May 11, the Defense Department’s director of test and evaluation acknowledged the project’s complexity and said the PMO “has rapidly incorporated lessons learned from testing” and set up a board with representatives from the military services to improve usability.

“It’s important to get MHS Genesis right,” Defense Health Agency Director Vice Adm. Raquel Bono said. “All of the insight gained during initial deployment has helped us improve MHS Genesis at IOC sites and prepare ourselves for future deployment. I’m fully confident we will build on successes on IOC and address challenges identified.”

JITC plans to complete testing at the fourth site—Madigan Army Medical Center—after a Cerner Millennium upgrade, re-engineering and other systems improvements can be made. Madigan is the largest of the test sites.

In a call with reporters Friday, Cummings stopped short of saying issues highlighted in the report would delay the planned full deployment of MHS Genesis by 2022. Feedback from end users, such as clinicians and health care practitioners, “will be the main voice who is going to tell us if the configuration is ready to move to next site.”

“Users are the strongest voice for how we move forward,” Cummings said. “So the purpose of this time in the acquisition life cycle is make sure we have the solution in the right baseline and configuration we can take forward to the next sites,” Cummings said.

The issues with MHS Genesis come as the Veterans Affairs Department is determining whether to move forward on a contract with Cerner Corp. to build the same electronic health records system for its 10 million veteran beneficiaries. VA chose to adopt the same health records system as the Defense Department last year under then-Secretary David Shulkin, but his recent ouster and political infighting have left the contract up in the air.

It’s not just the VA looking to latch on to the program. In April, the Coast Guard announced it would adopt MHS Genesis after years of unsuccessful projects—and billions wasted—trying to build its own system.

Article link: https://www.nextgov.com/it-modernization/2018/05/initial-tests-find-defense-departments-mhs-genesis-not-operationally-suitable/148165/

It’s time to ban productivity from medicine – Kevin MD

Posted by timmreardon on 05/14/2018
Posted in: Uncategorized. Leave a comment

| Policy | September 25, 2017

According to Wikipedia, “Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e., output per unit of input. Productivity is a crucial factor in production performance of firms and nations.”
Please tell me how this relates to being a physician or a patient. We do not produce anything. Rather we work with individuals to diagnosis, prevent, treat, and hopefully improve both longevity and quality of life.

ysicians work with individual patients.  We should strive to tailor care with our patient.

Productivity implies that we can count patient units.  That idea really disrupts the essential “why” question?

If you are unfamiliar with “why,” I highly recommend Simon Sinek’s book Start With Why. Why did we become physicians?  I think the answer for most physicians includes helping individual patients.  We strive to do our best for each patient.

Where did productivity enter our profession?  Most experts believe that Hsaio’s NEJM article, “Estimating Physicians’ Work for a Resource-Based Relative-Value Scale,” led to RVUs (relative value units) which many practice administrators use to measure “productivity.”  Hsaio, a noted economist, wrote in the abstract of that article:

We found that physicians can rate the relative amount of work of the services within their specialty directly, taking into account all the dimensions of work. Moreover, these ratings are highly reproducible, consistent, and therefore probably valid.

However, this model has led to gaming the system, and equating RVUs with hard work or productivity.  But many physicians believe that the RVU system provides many wrong incentives, the most important being that shortening visit time leads to more patients per day and thus more money.

I wish physicians could just ignore RVUs and spend appropriate time with each patient.  When physicians try to do this, practice administrators work to get physicians to see patients faster.

This leads to great stress for many physicians, and often unhappy patients.  Many physicians believe that shorter visits (especially with primary care physicians) lead to more testing and consultations.

Productivity implies that seeing more patients each day is a good thing.  But likely most patients and physicians will agree that we need to optimize the time with each patient.  How many patients can we comfortably see in one day and deliver high-quality care?  High-quality care does not refer to performance measures, but rather complex multi-dimensional factors that improve the patient experience.  For many patients, talking is both therapeutic and diagnostic.  We shorten our conversation time at the risk of diagnostic errors, higher health care costs, and dissatisfied, confused patients.

So please join the movement to ban productivity from medicine.  We are not producing anything.  We are caring for patients who need our full attention.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Article link: https://www.kevinmd.com/blog/2017/09/time-ban-productivity-medicine.html