Bringing Down a Bird of Thought: Homogenization and Standardization of American Medicine

The mind travels faster than the pen, consequently, writing becomes a question of learning to make occasional wing shots, bringing down the bird of thought as it flashes by.

E.B White,  Maine writer and essayist,The Elements of Style , 1972

June 7, 2012 -  I’m in Kennebunkport, Maine, summer home of the first President Bush. His home is  situated on  an outcropping off the Maine coast called Walker 's Point.

Speaking of Walker's Point brings to mind a point I shall try to make in this post - that what happened last night in Wisconsin,  where governor Scott Walker, the Republican governor of that state defeated an attempt to recall him from the governorship by a margin of 53% to 47%.  has national implications for Obamacare.   

Through this and other political victories,  the GOP hopes to bring down Obama as president and repeal  Obamacare, which symbolize big government and its entangling bureaucracy with loss of  individual  liberties . This bureaucracy is in the  process of paralyzing the practice of medicine.

This  brings me to a bird of thought-  the homogenization and standardization of medicine.  These  polysyllabic concepts restrict patient and physician freedoms by requiring an overarching bureaucracy going by the names of protocols, guidelines,  adherence to best practices, comparative outcomes, checklists,  and  following high sounding principles such as transparency and accountability,  as imposed through accountable care organizations.  Implementing and following these procedures takes time away from caring for patients and requires an administrative infrastructure which most medical practices do not possess.

At its best, homogenization and standardization may bring order, rationality, efficiency, predictability, and cost containment to the table.  But at their worst worst, homogenization and standardization restrict innovovation, clinical freedom, flexibility, choice, and converts medical practice into a polysyllabic and acronymic nightmare.

Furthermore,  it is extremely difficult to control the practice of medicine from the top-down.  Homogenization and standardization are  like Sisyphus. They never quite get the job done. The humanitarian needs of patients and doctors are too diverse, and their individual needs and choices are too complicated to divine by centralized government.  The Individual  actors in the medical drama need wiggle room, and they need more time seeing patients and less time expended in filling out paperwork and asking permission what and what not to do. 

That is one of the  principle reasons why 36% of doctors are no longer accepting Medicare and Medicaid recipients and why they are escaping 3^rd party restrictions such as payments by rigid coding  and by forming concierge and direct payment practices.   That is why health savings account plans are growing by leaps and bounds and now approach  20 million  members. 

Dealing with homogenization and standardization and central control is a continuing struggle, and it creates tensions between policymakers, payers, and providers.  

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