Wednesday, January 21, 2009

Change is good.

So I'm sure blogs all over the great wide world are talking about Obama and his great speech and how the world is changing right now, so why should I be any different?
Let me start by saying I am so so so so so so very glad to see Barack Obama as president. I just feel like his attitude aligns with mine on so many economic and foreign policies, and he's got great plans and he's not afraid to point out things that screwed us up. He's going to to a lot of good, I think. Except, of course, for healthcare.
He said two things in his (beautiful) inaugaral speech that touched on The Healthcare Issue, and I'm not going back to look at the exact quote or I'll never get anything done so I'll paraphrase. He said we will use technology to improve healthcare delivery. I got the impression, probably from other talk I've heard about budget allotment and planning, that he means that by pushing for an Electronic Medical Record (EMR) we will be able to give more organized, coordinated care. Sounds great, but the reality is computers can't make medical decisions. Computers, as we all know, are good when used correctly, and can make life much more complicated if not. I know too many doctors that have saved lots of time with thier EMRs (I hope) that now are incapable of writing a coherent note or summary of care. They click the template for the visit, add in if indicated, and off it goes to the pcp with an electronic signature, and I get a letter that makes no sense at all. (e.g. the "routine post op check, wound healing nicely, pt recovering well and can resume her normal activites", by the time i got the letter a week later, the patient was dead, I called the surgeon to ask why he thought she took such a sudden decline, he said that she was in fact very ill at her routine post op check, and not even walking without assistance, he was not at all surprised at her death, but her wound had healed well so he sent the standard note). So my point is, getting an EMR might help make good doctors more efficient (maybe), but they can also make bad doctors faster at being bad.
The next point of concern I had with President Obamba (which still sounds beatiful to say) is when discussing things that will change for the better, he said "we will lower healthcare costs". I wish people would stop saying we need to do that. It's not the care costs that need to be cut, it's the adminitration cost. (Ok, some care costs too). I feel somewhat threatened when people say that healthcare is too expensive. Health Insurance is too expensive, and some parts of health care costs are expensive, but it is unfair to lump them. I fear that "lowering healthcare costs" means lowering reimbursement for docs, and tradtitionally, the primaries lose out first. We need to reduce the administrative costs of healthcare, the wasted time spent on useless hassles, the unnecessary paperwork and multiple faxes and phone calls. We need to reduce healthcare waste by having a strong primary care system so studies and procedures and meds aren't duplicated. We need to reign in pharmaceutical costs somehow. And at some point we need to buy in to the fact that we as physicians have a moral, ethical, and economic responsibility to not administer care that we know is futile. Then, if we haven't saved any money, we can talk again.

Small scale change is good too. I'm getting ready to move into a different office, about a mile from my current one. I usually hate the stress of moving, but right now its not so bad. I like the opportunity to clean out the cobwebs, and get rid of the excess. (which is why there are 16 boxes of charts in my bedroom and hallway right now). I like chosing paint colors and deciding where furniture will go. Its just fun to step out of the grind, look at processes, and how they can be better. I might not feel this good about it in two weeks, when its time to be done and i'm not even packed, but right now, it's all ok.