Well-Care?

Yesterday, there was an excellent post at the "Health Beat Blog" by Maggie Mahar, in this post there is an excellent conversation between Maggie and Brian Kleeper here . I have to admit when I first read Brian's piece I was angry, but his overall point is sublime. Primary care has not united, taken the bull by the horns, or done anything to control their medical destiny, and in doing so (or not doing so as it were) they have left the door open for, and should fully expect such market driven medical clinics.

I must take just a few lines to discount some of the "advantages" as put forth by Brian, however I am doing so from a medical point of view, as opposed to Maggie's response which was more of a economic response.

First is the EMR, or electronic medical record, which is touted by him, and many of the com mentors as a way to improve efficiency in medicine both by tracking treatments and physician performance. If anyone reads my book (besides me that is) you will learn some interesting points about EMR. I am not against them, but I am an open critic. First, EMR is expensive, the software and licensing can cost up to 50K a year, being such they are designed not so much to support evidence based medicine but to support maximization of billing. Think about it, they are sold to administrators, in such the sales pitch doesn't talk about maximizing outcomes for obesity, they talk about how it will pay for itself in such in such a time. Speaking of outcomes, there are no, and I mean NO evidence based studies that show improved outcomes when the use of EMR is initiated!! I am not sure we would spend 50K a year anywhere else in medicine on unproven technology. I suppose I could write this whole blog on EMR (in fact I know I can), I will add just one more observation, as part of my current job I read medical records from all over the state, all day. The records that are the easiest to read are from EMR, but they are also the most inaccurate with the most internal inconsistencies, they are only as good as the tenacity of the person inputting and updating data GIGO (garbage in garbage out).

There are some serious ethical concerns with the a clinic that your boss pays for, chronic disease, recurrent illness, work place injury, drug and alcohol abuse, these medical/social topics being investigated and treated at your work place, by someone who works for your boss is well.......slippery to say the least. Maybe as a large employer the stats that I gather will cross reference with productivity, I will realize quickly that any employee with more than three to four visits a year is generally less productive?! Being that I am bound by law to work for my investors wouldn't I use this information to "weed out" less productive employees! There are many concerns here, the corporate world is not monitored closely enough to be trusted to operate such clinics.

Finally, in Brian's piece he writes about high performance and efficiency, I can't be sure but these terms seem to be applied in the economic sense, he did not quote any health outcome statistics. When we are talking about your health and the health of your loved ones, we should never stray from health outcome stats, never ever. Granted, statistics that help us maximize resource allocation should be considered and are incredibly important, but not when applied for the maximization of profits, it won't be in your best interest.

Brian is right though, primary care has failed to stand up and shout. We have not stood back to look at the big picture and said, "Yes, doing something to improve our situation will overall benefit the patients, and the community" we are cowards!! We are afraid to rock the boat.