As noted recently, when someone makes a joke about some of the ludicrous aspects of 21st Century mass medicine it shortly becomes true. Around Y2K it might have seemed hilarious that the government force emergency departments to lock up sterile water as a drug. And then, not content with locking up betadine as a dangerous potential consumable, JCAHO had their fun, and BOOM! water had to be locked up too. We here in Florida were half-laughing about how a really stupid government would start making doctors search the state database prior to writing any controlled prescription, and … that has become the law starting next week.
The instinct to herd, count, categorize, and collectivize every single thing in medicine should drive the very best minds – if those minds were thinking – into other careers.
John Stossel has a great mind and is sounding yet another alarm bell. He tells us how the Chinese ban potentially disruptive apps like Facebook, and forces their population to use more easily monitored platforms.
“Now the Chinese government takes data from those platforms to assign all people who use them a ‘social credit score.’
In other words, the government monitors your web activity and gives you a grade. Your purchases, social interactions and political activity will determine what privileges you get.
Having a low score — because you smoke, are slow to pay bills or criticize a government official — could get you barred from flying, using certain hotels or sending your kids to better schools.”
Bad news for China, but how far is U.S. medicine from the same? Wouldn’t major health insurance and hospital corporations love to be able to similarly corral an unruly workforce? Have you been on Twitter criticizing the ABMS, or contributing to Wes Fisher’s PPA? (shh, I have, and hope you have too). Have you publicly bashed the exorbitant premium increases Blue Cross is pocketing, and telling patients it’s a rip-off? Does you HCA-owned hospital know you favor DPC? There are all sorts of sticky unfair competition, restraint-of-trade complaints that could be made, but these deep-pocket evil bastards could always hide behind claims of being private entities not bound to hire or grant privileges to anyone, and win a financial war of attrition. The Acme Health Corp. could hire a room of computer thugs to write their own desirability programs to monitor and predict a doctor’s fitness to have active staff privileges. Were you at the last staff meeting, and have you ever been on the bylaws committee? Did you participate in the hospital’s back-to-school initiative held on the last Saturday of summer, when you wanted to be home enjoying the kickoff to football season? Has the CEO or any anonymous colleague expressed a concern about your “disruptive comments” within the past 5 years? Have you taken on any new Medicaid/Medicare patients in the last 6 months? Did you shoot the finger at the American Board of Extortion Medicine and refuse to take your re-cert exam? These could all cost you points on the desirability scale, which could be reported back to whichever insurance company to downgrade your reimbursements appropriately. There is already the onerous work of Press Ganey, and the ubiquitous, never-ending re-privileging applications that take up whole offices in even small hospitals. Going to a continuously updated doctor’s “professionalism score” really isn’t a leap.
To protect patients, wouldn’t your state medical board reasonably want to have the data from your local health system desirability monitoring? A physician not scoring in the upper 50% could be asked to do additional CME, just so the state could justify to poor, vulnerable patients that she really is a good doctor on the up and up. Oh it wouldn’t be forced, it would be that doctors’ choice whether or not to take the path of least resistance…for the patients’ sake. And is it too unreasonable for the state to expect its doctors to set a good example? Smoking, a high BMI, high lipids could all be reasons to downgrade your score. That’s data you could easily provide from your mandated yearly physical, all private and confidential of course – you don’t HAVE to do it or submit the data, but after all, practicing medicine is a privilege, not a right. And like insurance companies and hospitals, the state medical board is justified in doing whatever it deems necessary to protect patients. It would certainly be easy for these private, semi-private, and state concerns to all share the same “professionalism” evaluations.
And that’s no joke.