Jesus Christ EMR

Obama seems to have totally hit the Kool-Aid bong about EMR’s saving the American Health Care system.

Go! Go! Go! Go! EMR! EMR! EMR!

He’s not the only one, either. I recently heard some analyst yakker on PBS proclaiming in breathless tones that instituting and EMR would lead to such better health in America that it singleRAMedly would lead to all the cost savings we’re looking for in our health system. She was so spun up about it at one point I thought one of the other interviewees might suggest she get herself a room so she could give herself a little tension-release (or at least re-powder her face).

EMR’s only barely improve medical care. The overhead costs – in maintenance and updates of both software and hardware – is tremendous. They worsen charting time because they have so many boxes and forms to click and fill out on every patient. They do nothing to prevent or protect against litigation.

Their biggest utility is, so far, a theoretical one. Connectivity. If everyone in our country had their medical record in the same system, you could see a doc in Tulsa one day and Tacoma the next, and both docs could essentially function as the same care provider because they could both see the same record and continue each other’s plan.

But the idea is a myth.

Oooooooo. It glows....Bzzzz, bzzz...

This is a capitalistic country, so there’s dozens of EMR companies fighting for market share. There’s lots of venture capital involved because this is a big game with HUGE payoffs if you win it. Each EMR has some merits; NONE of them talk to each other. By none, I mean NONE. The EMR’s hate each other. They’re Mortal Kombat enemies. I’m being as genteel as possible when I describe the standoff with words like hatred, vituperation, caustic acid on mucous membranes. Get it?

Even if the EMR’s all went to counseling and became friends, the governmental obsession with medical privacy – so onerous it is now unreasonable – requires Pentagon-level encryption that nobody can afford in both time and money.

To log onto my EMR, for example, I have to enter a number from a digital keychain that refreshes itself every 3 minutes, plus my user name. I then have to enter my username and password at 2 other stages, all of which are preceeded by boot-ups, loading pages and security cross checks.

As mentioned, it turns out that charting in EMR’s takes longer than charting on paper. This means doctors will see fewer patients and spend more time charting.

Keep in mind that I’ve semi-rigorously calculated that I already spend at least 30 – 50% of my time totally avoiding patients and patient care so I can document. So, when you hear that we have a doctor shortage in this country, assume what is meant is that we actually have the right number of doctors… but because only half of their time is spent actually doctoring, we’re really about 50% short on docs.

Still I love techololgee...TURN IT OFF! TURN IT OFF!!

If you look at good socialized health systems around the world, you don’t really see many EMR’s. In fact, obsession with glowing technology is what gets American medicine in trouble all the time. We already order too many high-tech tests that do nothing to increase life expectancy or quality.

The cost of our health care system isn’t a result of not having an EMR. Our costs are driven by all the extraneous junk that makes us uniquely inefficient.

Follow the Liiiight, and You Shall Be Saved

Look at good health care systems, and the main thing you don’t see is entire industries piggybacking on the cash cow of medicine. Insurance companies are heavily regulated, and thus make reasonable profits. Some are government-administered and make no profit at all. Litigation is highly limited, preventing not only absurd payouts, but also preventing the much larger hidden costs to the system, which is excessive testing and charting meant to protect doctors and hospitals from dreaded litigation (the irony is, it doesn’t).

More technology is just more expense. What we need is less. Less specialization. Less litigation. Less technology. Less capitalizing on the sick among us. EMR’s are not the Jesus Christ of the American Medical system. They probably won’t help at all.

Technology won’t solve this problem, only common sense will.

Comrade Bush

My dear readers – please prepare yourself for some rather feisty political and religious ranting (below).  I’ve largely avoided politics on this blog, as well as religious issues.  But not today.  This blog is about catharsis for me as much as it is a record of my observations and experiences in the medical world.  Therefore, today is a day to respect this former purpose.

To add some background to the entry, you should know that I was raised in a politically-conservative home that also was highly religious and active in the Protestent, non-denominational Christian belief system.  We had a picture of Newt Gingrich on our fridge.  We strongly supported Amendment 2 in Colorado a few years back – a hyper-conservative law disallowing gays to claim discrimination in hiring (since declared unconstitutional).  We hated Bill Clinton and constantly lauded Ronald Reagan.  Since voting-puberty, my presidential votes went: Bush I, Dole, Bush 2, Bush 2.

Since my second vote for Bush 2 however, things in my mind have changed dramatically.

I welcome your comments, condemnations and replies.  Or, perhaps, you’re already bored since this post is political rather than medical.  But, for better or worse, here ’tis:

I can’t  believe how much I hate W.  I’m so pissed that I voted for him…twice.

Hugo Chavez is calling him “comrade” because his vacuous and impotent bailout plan is so communistic.  He calls it ‘Communism for the Rich’.  And, lest we forget, McCain VOTED FOR BUSH’S BAILOUT…never even condemning the 1.5 billion in moronic pork projects that the second plan required to eventually pass the House.

There are no conservatives anywhere near D.C. anymore.  I largely blame Christian Conservatives for this because they have let social-control issues dominate their thinking so much that they’ve totally lowered their standards on genuine conservative governmental policy.  With the takeover of the banks, our government is bigger and stronger than the centralized government of the Soviet Union.  What happens when our government (vastly different every 4-8 years) is taken over by atheists, or radical islamists, or strict anti-religion nuts?  Imagine Hitler at the helm of a government as capable of oppressing its people as ours has become.

Christians should vote to keep the government WEAK, not moral.  They voted for W. because they thought he was a moral guy who opposed abortion…he then used his 8 years to make the government more capable of persecution than ever before in American history.  Ironic that Christians fled to these shores because of an overbearing guy named “George”.  Now another George has put them right back in the same place.

EVERY conservative Christian in America should have been marching in the streets for a little guy from TX named Ron Paul during the primaries this year (although Obama shows a reasonable respect for constitutional rights as well).  Paul is the only strict fiscally-conservative constitutionalist who had a shot at the presidency.  Instead, they rallied for Huckabee – called “The Huckster” by his constituents for his renowned inability to pass up shady financial deals – because he promoted himself as hyper-opposed to abortion.  But opposition to abortion is nothing more than support for extremely invasive nearly-omnipotent governmental oppression of civil liberties. Please understand that I say this as one who is totally and completely opposed to abortion for birth control at any trimester. Other than in life-threatening situations, I will never perform one under any circumstances. This, for the moment, is within my civil rights.

Christians have lost their way politically because they put the singular issue of forcing others to believe as they do about abortion on such a pedestal that it has become an idol.  Dreaming of a government so powerful it could literally monitor and control the genitals of women and the doctors who care for them, Christians have allowed government to grow into a terrifying power.  They should have been vigilant about protecting their right to worship, which requires robust civil liberties.  Instead, they voted to force others to see issues they way they do, no different than Muslim extremists.  Not only are they losing on those issues (abortion will NEVER be outlawed.  EVER.), they are now in a position to lose their freedoms, too.  Thanks to GWB, the U.S. Government is geared for total and horrific oppression of Christians…and other religions or belief systems as well.

The only question is when it will happen.

Given the way Christians pillory the press – the only remaining vanguard against oppressive government – I am convinced that politically-active Christians are the single greatest threat to civil and religious freedom in America.  They urgently need to go back to their Bibles, their families and their jobs…and shut the hell up.

Politically-active, conservative Christians are destroying America.

Saturday Night Quotes I Like – March 1

A compendium of quotes I’ve noticed over the past week that were provocative, thoughtful, interesting, funny or patently absurd.  Sent out (’Lord tarry and the creek don’t rise’) every Saturday:

  • Health nuts are going to feel stupid someday, lying in hospitals dying of nothing. – Redd Foxx
  • Astounded, I pointed out the obvious. “Your wife died, you stopped eating, cried or slept all the time…and prayed to God that you would die? Sounds like you are very depressed.””No, I’m not depressed,” [my patient] said. “I just don’t want to live anymore.” – Fat Doctor
  • After saying she found her “voice” in New Hampshire…we’ve had Experienced Hillary, Soft Hillary, Hard Hillary, Misty Hillary, Sarcastic Hillary, Joined-at-the-Hip-to-Bill Hillary, Her-Own-Person-Who-Just-Happens-to-Be-Married-to-a-Former-President Hillary, It’s-My-Turn Hillary, Cuddly Hillary, Let’s-Get-Down-in-the-Dirt-and-Fight-Like-Dogs Hillary. – Maureen Dowd
  • buck.jpgBuckley was arguably the most important public intellectual in the United States in the past half century. For an entire generation he was the preeminent voice of American conservatism and its first great ecumenical figure. – George H. Nash, American conservative movement historian.
  • “Even if one takes every reefer madness allegation of the prohibitionists at face value, marijuana prohibition has done far more harm to far more people than marijuana ever could.” – William F. Buckley, Jr.
  • “I won’t insult your intelligence by suggesting that you really believe what you just said.” – William F. Buckley, Jr.
  • Buckley’s greatest talent was friendship. The historian George Nash once postulated that he wrote more personal letters than any other American…He showered affection on his friends, and he had an endless stream of them, old and young. – David Brooks
  • Faith, which is the belief in the supernatural despite lack of evidence, is, in the terms of some theologies, a gift from God. It is the belief in things not seen…Anyone can believe in a God who walks the Earth. – PalMD
  • A physician who treats himself has a fool for a patient,” – Sir William Osler.
  • …New physicians view medicine more like a job than a calling [while]…politicians and the public have decreasing respect for the profession. In addition, the constant siege by the lawyers is taking its toll…in such hostile times, why should doctors sacrifice more to the profession than they already have? – Kevin, M.D.
  • Today, thanks to the Internet, we are all physicians. And potential fools. – Andre Picard
  • Intubated COPD patients are generally stable patients..[with a] protected airway…[in a] controlled environment… Except when they aren’t.Happy Hospitalist
  • When I was a child, it was an easy time to dream. When you turn on your television set and men are landing on the moon, anything is possible, and we should never lose that spirit. – Randy Pausch, professor at Carnegie Mellon currently dying of pancreatic cancer. See his final lecture on following your dreams here.

Clinton Video

It has been said that people dislike HRC because she is a woman, etc.  I’ve always found this insulting, having been raised by a single mom who was smart, strong and capable of running a business quite well. I’m a fan of Margaret Thatcher. I would be happy to see a woman in the Oval Office.

Just not Hilary. 

I dislike her because I think she is deceptive. I also think she is short on true, creative ideas.  The “change” moniker, for example, showed up in New Hampshire after she was flattened by Obama who had been focusing on this theme from the beginning.  Furthermore, the “experience” thing is completely disingenuous.  White House furniture-picker is not experience.  Watching her husband weather Republican attacks is not “beating them”.  Nearly destroying American health care – her only real executive excperience – is rightfully quite distanced from her stump speech resume.

Ultimately, I believe Hilary Clinton is primarily motivated by power, and has been since before she married Bill.  I don’t want a control freak running the country, I want a public servant. Here’s a pretty good video that also makes my point:

Obama Bumper Sticker

I’ve hated watching politics as usual from the Clinton camp. In particular, her claim that she has experience because she nearly destroyed health care in America and chose the decor in the White House for 8 years. And anyway, some of the best presidents in history had little more experience than proverbially laying down their plow, serving their country for 4 or 8 years, and then going back to their simple life on the farm.

So, my response was to come up with a bumper sticker. You can buy one, here. They’re $3.50 (bulk pricing available). Here’s what it says: