An IT Love Letter by Pat Conrad MD

mosty-2

Dear Dr. Mostashari,

Prior to reading your interview in Medical Economics, I had only heard of your office, but didn’t know specifically who you were. Based on your previous job title, I would have guessed that you got your medical degree in the Ivy League, and I would have guessed that you had a real love for population contr-, sorry, population health. I’ve read also that you hooked up a bunch of New York doctors in underserved areas with electronic health records, and that you worked for several government agencies on the way up the ladder to your job as National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.

Funny thing, I couldn’t find in any of your online biographical info where you had actually seen patients on a daily basis after you left residency, or that you had any experience in trying to start a struggling small business. It seems like that would have been valuable experience for a guy paid to enforce “Meaningful Use” on the majority of physicians. On the other hand, maybe blissful detachment allowed you the objectivity to make a statement like: “I think Meaningful Use became too much about compliance and not enough about outcomes.” Yeah, if you lived in fear of the government the way most of your less well-connected colleagues do, then you would have already known that compliance has replaced a lot of “outcomes.”

Technology can be pretty cool, Dr. Mosty, but it sure can be pricey. One recent national survey described costs somewhere between $50,000 – $200,000 for a two-physician practice. A 2014 Medical Economics piece noted “nearly 45% of physicians from the national survey report spending more than $100,000 on an EHR.” Many docs have found that the implementation costs and hassles were not worth the MU bonuses from your office, and the majority of large group practices said that EHR’s were not worth the effort. Fortunately you didn’t have to worry about their little gripes while providing leadership, backed of course by government force. Gotta hand it to you Doc, you saw a government initiative, forced it on your colleagues, and jumped on the winning team in the very best tradition of K-Street lobbyists and expensive defense contractors everywhere. As you said, “As bad as some of the usability issues are with the EHR’s today, I don’t see people going back to paper. And it is the foundation for doing more things.” Boy you said a mouthful Dr. Mosty – can I call you that, just to keep it casual ? – like when you asked “How does this now become the infrastructure for doing more and in a more “Internet-y” way? Can I use other tools on top of and around and attached to my EHR? And for that, we need to open up those EHR’s to third-party applications.” You’re clever Dr. M., you never made the mistake of asking any private physician if they wanted to do more, and in a more “internet-y” way – you knew what was good for us and you told us what to do (and psst, Mosty, just between me and you, we both know that the “compliance” unpleasantness that you feigned regret over is what actually lets you tell the rest of us what to do. Wink, wink).

And talk about big brass ones, you da man! It takes major, top-down chutzpah to say straight-faced in an interview that, “I think that one of the major causes of [physician] burnout isn’t the EHR per se. It is this loss of control and feeling that you’re not in control … whether it’s the rising cost of everything and the decreasing reimbursement for everything and new rules that come out that you cant even understand.” And you claim you haven’t per se thrown gas on that dumpster fire? My friend, as an already accomplished bureaucrat, you have great potential as a politician. Then you doubled down with the story of your friend who closed her practice, not over EHR’s, Meaningful Use, or ACO’s – all the stuff you sell, wink, wink – but because of the “accumulated frustrations of trying to be a small business owner and trying to stay independent.” So you don’t think that shelling out half a mortgage for an EHR is an “accumulated frustration”?

Of course Dr. Mosty, you can’t possibly want physicians to be independent, or you wouldn’t have led the charge in cramming all this expensive, independence-shredding gunk down our formerly private throats. I was particularly interested in the double-talk somersault you pulled in the interview with your cute kayak analogy, telling us how we need to paddle hard, or in your words, “So be more active. Don’t be passive. Take control.”

And then in the very next damn paragraph, you say that taking control is NOT “to retreat into some direct primary care model. That, to me, is not a solution for all of our docs to say, “I’m not going to take insurance.” That’s not a solution. We have to find ways of coping with the change and feeling more in control.”

In your own words, you want me to keep giving you control as a way of feeling more in control. In other words, Mosty, you want me to eat spinach and “feel” like it’s ice cream.

Dr. Mostashari, you are a paragon of the New Doctor: a government-funded population control officer, who doesn’t have to meet a payroll, cover overhead, or see patients. You guiltlessly use your connections to build your own career and pad your bank account by selling out your colleagues to lesser bureaucrats, armed with all the “compliance” that comes with government force. You will be praised for your leadership in teaching others to get with the program, and you’ll be able to retire early, and quite comfortably, by selling more bad ideas and products for the government to punish us with. You represent so much of what I hate about medicine, and you embody the dishonesty at the core of this industry. You probably think you are a good guy, doing good work for great masses. But suggesting that escaping into Direct Primary Care is not a way of taking control of one’s profession puts the lie to your success and your sales pitch. Whatever you are in your personal life, you are professionally a bad guy, a slick data huckster selling snake oil that the crowd is forced to drink. Here’s hoping that when you need one, you get the medical technologist you deserve.
With all my data,

Pat Conrad, MD

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] 

  15 comments for “An IT Love Letter by Pat Conrad MD

  1. Katherine Galarza
    September 8, 2016 at 1:52 pm

    No question this hit the heart of the matter and now I am off to find a different career for my great work ethic and excellent brain. I am tired of the pot of boiling water and the continued insistence that the hot water shouldn’t hurt.

  2. Fitz
    September 5, 2016 at 10:59 am

    You went right to the core. Thanks, please write more.
    Fitz

    • Pat
      September 5, 2016 at 5:10 pm

      Thanks very much Fitz. For clarity’s sake, my nickname and nome de plume is Fitz Conrad. If you like the writing (shameless plug) please look me up on Amazon: “When in Doubt, Choose Freedom”

  3. mamadoc
    September 4, 2016 at 10:19 pm

    AMEN!

  4. Howie
    September 4, 2016 at 6:26 pm

    Fantastic! Agree with everything said. We need more love letters to be written and maybe read.

  5. Lady Tap Water til Clear
    August 31, 2016 at 10:11 pm

    I agree with everything, I just have a small issue with the term medical technologist.
    Currently I am a nurse working in Home Health (which I love) and have been for several years.
    Previously, I was employed as a medical technologist in clinical chemistry. Loved it too, but I had to do something to make a little more money to put two kids in college.
    I would expect Dr Mosty to encounter his own lofty well educated kind if he every needs health care. (And the nurse who knows KY is optional)

    • Pat
      September 1, 2016 at 8:46 am

      Hi Lady – I’m not slamming med tech’s at all, merely pointing out that Mosty and his garbage are reducing physicians to that level, which isn’t good for anyone.

  6. Glenner56
    August 31, 2016 at 5:53 pm

    OMG. To the heart!! I love it!!

  7. August 30, 2016 at 9:32 pm

    Thank you! Thank you! Thank you!

    I appreciate someone who isn’t so shy, timid, politically correct – or whatever it is – and speaks their mind. Too often in this world we have people who don’t; who go along to get along; who fear that someone will think ‘negatively’ of them.

    This is what is wrong with our world nowadays. Too many wusses who are afraid to speak their mind and take a stance. Sometimes people – int his case Dr. Mosty – need to be taken to the wood shed. What kills me about these so-called ‘public servants’ is that while they are ‘serving the public’ they and their supporters often say “But he/she’s serving the public and not making what they could in the private sector.’ Then they leave public service and make a boatload of cash working on something that they themselves essentially put into place.

    geez…

  8. Hawgguy
    August 27, 2016 at 9:28 pm

    Pat, tell us what you really think, don’t sugar coat it.
    Terrific!

  9. George Voigtlander
    August 27, 2016 at 8:21 pm

    Have agree with Dr Conrad on all but one point. It’s not snake oil that Mostashari is selling, it’s Jim Jones flavored Cool Aid with a twist of MU $.

  10. August 27, 2016 at 11:49 am

    Brutal assessment of the New World Order in medicine and precisely what needed to be said in response to the Medical Economics interview that did little more than throw soft balls to “Dr. Mosty.”

    Well done, Pat.

  11. Sir Lance-a-Lot
    August 27, 2016 at 10:50 am

    Thank you, Pat. I don’t think I could possibly add to that.

  12. HJR
    August 27, 2016 at 10:36 am

    F-ing A.

  13. Steve O'
    August 27, 2016 at 10:32 am

    This is a great essay. The definition is chilling, and precise:
    New Doctor: a government-funded population control officer.
    Real physicians are disliked because they are feared. They are feared because they claim the capacity to see and understand something, and then react decisively to address it. This is a terrifying quality to the bureaucrat. In their eyes, this is little different than the mugger who robs and stabs a victim. Why are they doing this? Some uncontrollable process going on in their head.
    The society that cannot tell a mugger from a doctor is in great danger. Every profession which arrogates the right to decide – schoolteacher, police officer, physician – is being hemmed in and crushed, punished for their audacity.
    I saw a patient for the second time, a week after the first. He has AF and bad cardiomyopathy. The Wise decided to anticoagulate him on warfarin. There is a highly sophisticated program for multi-level team monitoring and tracking of his INR, which peaked at 7 and he bled into his leg; he was hospitalized and released; his INR peaked again at 7 but this time without a bleed.
    The patient saw me for the first time, and said “Doc, I think they’re trying to fucking kill me!” specifically meaning the medical establishment.
    I knew then that I had in my hands a very perceptive and astute person, whose life I would struggle to the utmost to save.
    I estimated his risk of embolic stroke and other problems, and his recent two events of “They were trying to fucking kill me!” By discussing the matter with the patient, under informed consent, he competently decided to stop warfarin.
    The crowd went wild, and not in a good way. He was unplugged from the Warfarin Process, who carped bitterly and mostly behind my back about taking bad care of the patient. I offered the patient’s documented informed consent; they sneered. I wrote in the chart that the patient equated anticoagulation with “They are trying to fucking kill me!” This inspired much complaint – the language was found to be salacious and rude, unacceptable for the chart. I offered that I was quoting the patient, and I am but a scribe.
    The Warfarin Mob retreated, complaining bitterly that the patient was acting AGAINST MEDICAL ADVICE. Should he expire, be hit by a bus, any time over the next year, I am sure that a standards complaint will be filed against my practice technique (and not for the first time.)
    Medicine, like football, is far more fun to criticize than to perform. That’s why they pay the players so much, but the fans themselves have to pay to attend. The actual playing of football is terrifying and dangerous. It’s so much more rewarding to lick down a few beers and boo the quarterback for throwing an interception.
    Medicine’s becoming a spectator sport. I’m one of the dinosaurs who gets down on the field and blocks the defensive lineman, again, and again, and again, etc.
    Kudos to the New Doctor! They may wear whites that are pearly white and cost $300 for they will never become dirty, except perhaps at the elbows.
    Thanks for the great essay!

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