Please, I Don’t Wanna Nag by Pat Conrad MD

Not to pile on…(see “Social Determinants”.)

Maybe the biggest obstacle in returning control of health care to actual physicians is one of simple numbers.  Much as I hate the term “stakeholder”, there are so many self-appointed of those circling around health care, all protecting and expanding their turf and their pointlessness, that they simply overwhelm physicians with sheer tumor bulk.

Take for example “Zsolt Nagykaldi, associate professor and director of research in the Department of Family and Preventive Medicine at the University of Oklahoma Health Sciences Center, and an international team of primary care researchers.”  Nag et al want to reconfigure EHR’s to reflect patient’s “life goals”, however the hell that might be interpreted.  Here’s a gem of explanation:  “Our healthcare system focuses on individual diseases rather than overall health and oftentimes puts the achievement of goals of the clinicians ahead of what the patients really need to achieve longitudinally in their lives.”  The reader will not be surprised to learn that Nagykaldi is not a physician.

I know, helping patients to pursue their own happy lives seems like a proper goal, but you and I know about those good-intention pavers.  “According to Nagykaldi, clinicians are not currently able to include the ‘fullness of the patient narrative’ in EHRs in a way that is actionable.”  Uh-oh.

These improvers want to build EHR’s around core patient profile characteristics and “health planner functions”, which would then be cross-linked through the chart.  It’s not a stretch to fear that certain characteristics would begin to demand canned, rote responses, which if not entered, would result in deficiencies and penalties.

In this Age of Quality, the Nag Group wants to move away from free-text notes, and expand the amount to patient information entered as “structured data.”  This data would include “actionable socio-cultural and socio-economic information, life and health goals, care preferences, as well as personal risk factors.”  How would cultural or economic factors be “actionable”, and why would a doctor want to spend dwindling time and energy on “actioning” them?  More ominously, every one of these socio-economic-cultural-life-goal-action-opportunities would be turned into data points, and then into quality indicators to be dutifully, fearfully catalogued on pain of financial penalty.

A lot of us have had to pay money to do that idiotic “cultural competency” module for the family practice MOC, and know how insultingly pointless it is (Hint: Bombay gin helps while taking it, at least to celebrate a little cultural imperialism).  And don’t think it will be as easy as just checking off fifty or one hundred economic/cultural attributes (has the patient ever been a gun-owner of Indonesian descent who hopes to pursue paddleboard yoga as a career?) and entering in all this meaningful data, nosiree…

“To accomplish this, a new taxonomy for personal health attributes needs to be developed that incorporates categories of patient goals (those related to life extension, health-related quality of life, physical functioning, human development, end of life, and healthcare relationships). These attributes will then need to be linked to evidence-based strategies that can promote the achievement of patient goals.”  And that’s where the “actionable” is.  Another wheelbarrow load of toxic bullshit that will not improve actual medical care, and about which the doctor gives not a damn, but for which he will be penalized (and if someone is lucky, sued).

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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] 

  6 comments for “Please, I Don’t Wanna Nag by Pat Conrad MD

  1. Bridget Reidy
    March 30, 2018 at 5:32 pm

    Don’t we discuss goals every time we propose an action? More exercise will do x for you, this pill will lower your BP and hence your future risk of…, then they decide if they like the goal, or say I know and I don’t care about that, or I’d rather pay my rent. It’s been ages since any patient asked me to just tell them what to do.
    I agree it’s all about data entry, or not paying for ICU stays and resuscitations for those who wouldn’t want them, and we could do a little more on that if someone would just pay us for our time instead of if we check a box. It would be pretty dangerous to ration health care based on a box check from someone who really wasn’t given enough time to do it carefully and honestly, or from an online educated LELT.

  2. Jennifer Hollywood
    March 29, 2018 at 8:37 am

    Oh great. I just love to click boxes. I just can’t seem to click enough of them at appointments. I have been only minimally satisfied by clicking “BMI info” and “tobacco use” and “use of beta blocker after MI” and ” hemoglobin a1c under 9%” and other such senseless reporting parameter. Now I can also click on things like “patient is happy and fulfilled” and “patient’s life goals are being met” and “patient feels like they are getting enough sleep”.

  3. Mary Carney
    March 28, 2018 at 9:28 pm

    I actually can take care of one patient at a time.
    I refuse to be responsible for the whole population

  4. Perry
    March 28, 2018 at 11:27 am

    What sickens me is that all this is about data collection and the illusion of health care. If “they” really cared, “they” would make life so much easier for Primary Care so we could recreate the physician patient relationships and connections that made so much difference in the past.

    And I agree the cultural competency module was BS. I don’t think they liked my comments.

    • Kurt
      March 28, 2018 at 5:16 pm

      Problem is they have a 4 letter word scrubber that kicks out the survey if found. That’s the reason why all of these BS organizations like the AAFP paints “rosey” pictures about how its
      membership “feels”.

  5. Mario
    March 28, 2018 at 9:07 am

    Medical Marxists by any other name is still full of empty promises and a dead end future.

Comments are closed.