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).