Another Example of Industrialized Healthcare



I saw this article in the NY Times that was written by a nurse and points out the garbage they have to do that has nothing to do with healthcare.   Here are some examples:

  • A friend was recently hospitalized after a bicycle accident. At one point a nursing student, together with a more senior nurse, rolled a computer on wheels into the room and asked my friend to rate her pain on a scale of 1 to 10. She mumbled, “4 to 5.” The student put 5 into the computer — and then they left, without further inquiring about, or relieving, my friend’s pain.
  • A nurse could spend 10 minutes documenting a patient’s fall risk, or 10 minutes trying to keep patients from falling.
  • Hospice care is a covered benefit under Medicare, and the Centers for Medicare and Medicaid Services maintain rigid standards for documentation. They regularly withhold reimbursement if documentation is deemed incomplete or flawed.
  • Charting a hospice admission usually takes between two and four hours, and requires filling out a seemingly endless number of data fields — some of them defying logic. I once had an oxygen-dependent centenarian patient in heart failure seeking admission to hospice. The hospice physician asked for further proof that the patient met the strict standards for hospice admission. It was a weekend, and during the time it took for me to collect that information, the patient died.
  • The worst, though, are the health risk assessments done for patients in Medicare Advantage, a program that pays for their coverage under certain private insurance plans. These assessments include an exam, an accurate health history, and diagnosis and documentation of the most serious possible version of the patient’s illnesses. This is known as diagnosis “capture,” and the entire process is colloquially referred to as “upcoding.” Because upcoding classifies these patients as higher risk medically, Medicare increases the reimbursement given to their insurance companies without requiring that patients’ new, more severe diagnoses be treated in any way. Independent companies exist to do these evaluations, and according to an exposé published by the Center for Public Integrity in 2014, they cost our government billions of dollars every year.
  • Sadly, all the attention given to our paperwork is taking us further and further away from the difficult truth that meeting very ill patients’ needs occurs in real time with real people, not in the paperwork about them.

This is where our medical system is headed.  It is called Industrialized Medicine or Healthcare and the sad part is that in the future the new nurses and doctors will accept this crap as the norm and not think for a second otherwise. That is where we lose all humanism and the job of doctors and nurses can be all automated.  On the bright side, though, is that the increasing number of administrators will continue to get their medal, awards, accolades and healthy bonuses.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Another Example of Industrialized Healthcare

  1. Perry
    December 22, 2015 at 9:57 am

    Yep, it’s all about the documentation, folks!

  2. Stephen Rockower
    December 22, 2015 at 9:10 am

    It’s all Magical Thinking

  3. Steve O'
    December 22, 2015 at 8:25 am

    Interesting, as just yesterday I noted one of my asymptomatic elderly patients be slowly fed into the woodchipper that is industrial medicine, consider-this and rule-on-that, all sorts of rubbish until he winds up with a bill for a $1000-a-month medication that he does not need.
    Five minutes of competent thinking could lead to his proper care – but there’s no time for that.

  4. George Voigtlander
    December 22, 2015 at 7:34 am

    “There is no substitute for quality”; but they cynically keep trying to defraud the public with the crap you point out. The real tragedy is that people don’t get what pay for and need.
    Hospice patients want someone to help them make sense of their lives, even more than pain relief. Too often they get twenty five pages of a bogus database.

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