Friday, May 27, 2016

Are G.O.D. (Good Old Days) Coming Back?
In G.O.D we trust, all others use data.                              
This blogger’s play on words
Forgive me.   I have a weakness for creating acronyms critical of well-intentioned but misguided government interventions into the health system.
W. Edwards Deming (1900-1993), a statistician, was famous for saying, “In God we trust, and all others use data.”  Deming was referring to data as the only reliable way to measure quality and gauge continuous improvement.
His statement was a forerunner of the current measurement craze over algorithmic data as the best and only means of controlling health care quality and containing costs.  This management mindset has popularized and characterized the movement towards evidence-based care, pay-for-performance pay for physicians, and data-based population health as the way to improve outcomes and decrease costs.
This movement has met resistance among physicians, who insist you can’t judge physicians by numbers alone, and patients, who would rather not have the details of their care and illnesses exposed to the world through personal data exposure to the government or anybody else.
A study of electronic records by the California Health Association of 1587 adults found that 15% said they would lie to conceal information “if the doctor had an electronic record,” and another 33% would “consider hiding information .” Another study , conducted by GE, the Cleveland Clinic, and Oshner  Health System said 13% of patients fibbed about exercise,  9% about diets,  9% about taking their medicine,  7% about drinking,  7% about smoking,  4% about taking  illegal drugs, and 4% about unprotected sex (Medinnovation and Heath Reform,  “Survey; Patients May Lie if Electronic Records Are Shared,” April 17, 2010),
Which brings me to the news of the day.    Kaiser Health News reports that A 41 year old psychiatrist says 55% of psychiatrists now charge patients directly  rather  going through 3rd parties (“A Doctor Yearns for a Return to the Time When Physicians Were Artisans” and “Doctor House Calls Saving Medicare Money.”  Doctors and patients alike are seeking more private, personal, home, decentralized,  confidential  care based on mutual trust, outside the reach of electronic health records.
The Good Old Days  are , of course, unlikely to return, given the penchant for  the importance  of  time spent documenting   over time spent doctoring.   Asgovrnment continues to cut  provide pay,  doctor  consolidation  will roll on over the next decade, and federal and private insurers will insist on data  rather than on trust between doctors and patients to do the right thing.  “The future “, as Yogi Berra noted,” ain’t what it used to be.”
However, there’s a search out there for more personal care, based on trust between patient and doctor without intrusion by data-seeking computers.   Patients want refuge  from the  digital revolution, where nothing is hidden and everything is known about the personal habits,  illness details, financial status, and health care shopping patterns of patient.  Doctors are seeking to escape from expenses, irritations,  and delays of hassles  and prohibitive overheads imposed by 3rd parties,   Patients yearn for a more trusting , confidential relationship between them and their doctors and more eye-to-eye contact with a personal doctor, absent an interposed computer, recording every detail of the encounter.     Total transparency is overrated .   Some things should be kept private

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