This Could Never Happen by Pat Conrad MD

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.

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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]edicine.com 

  6 comments for “This Could Never Happen by Pat Conrad MD

  1. Hawgguy
    June 26, 2018 at 11:32 am

    I recently had a mandatory (to avoid a $30/month penalty) “wellness” exam. I politely submitted. When asked about my firearms at home I politely recalled the “tragic boating accident”.

  2. Steve O'
    June 26, 2018 at 8:44 am

    Not to get all John Lennon on you, but Imagine an organization with these rules…
    -Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis by building quality into the output in the first place.
    – The aim of supervision should be to help people and machines and gadgets to do a better job. Supervision of management is in need of overhaul, as well as supervision of production workers.
    -Drive out fear, so that everyone may work effectively.
    -Break down barriers between departments.
    -Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
    -Eliminate work standards (quotas). Substitute leadership.
    -Eliminate management by objective. Eliminate management by numbers, numerical goals. Substitute leadership.
    -Remove barriers that rob the hourly worker of his right to pride of workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
    Remove barriers that rob professional employees of their right to pride of workmanship. This means, inter alia, abolishment of the annual or merit rating and of management by objective.
    You may say I’m a dreamer, but I’m not the only one
    This is simply the TQM line of business management principles laid down by W. Edwards Deming. The TQM idea has been diluted into meaninglessness by bureaucracies past.
    It is the antithesis of the IOM movement that is snuffing out humanity in medicine.

  3. Steve O'
    June 26, 2018 at 8:17 am

    Big Brother offered me a deal today as a patient:

    You’re so close to earning a wellness reward! All it takes is 10 minutes. You’ll answer questions about your health and your lifestyle, current medical conditions and any tests or screenings you’ve had recently. After you’re done, you’ll get a personalized action plan with steps you can take to improve your health. Plus, you’ll earn $50 on your X® Wellness Card the first time you take it this year.

    I read above Now the Chinese government takes data from those platforms to assign all people who use them a ‘social credit score.’ The difference appears to be that the socially industrious Chinese actually took the time and energy to spy on their people, whereas my employee, the nuisance that takes my money to provide an overpriced service, wants me to to the snitching on myself. Of course, I eat only egg whites and rice cakes, jog daily and keep my BMI under 20. Yah.
    Bureaucracies instinctively cannot recognize good behavior, but can only identify and punish bad behavior. That is why everyone loathes Press Gainey – it offers no commendations but points out questionable blemishes. It exists to lower the “rating” of the physician to lower the salary of the physician. Identifying good practice is off their radar.
    I’d like to add onto this in a few minutes a comment on a key turning point in American medicine, the publication of To Err is Human: Building A Safer Health System The aim, which appeared at first to be minor and limited, was to reduce errors in the healthcare system. This concept has risen to engulf the character and mission of the entire healthcare system, as it has in many other areas. It now reads “”To Err Is Human, To Dehumanize is Divine.”

  4. Rick M Singel
    June 26, 2018 at 8:00 am

    Great piece. I dearly love this blog. I think my eyes are wide open, but they get wider with each blog I read. So, thanks.

    • Doug Farrago
      June 26, 2018 at 8:57 am

      Thanks, Rick.

  5. Perry
    June 26, 2018 at 7:56 am

    Big Brother is here…

Comments are closed.