Tuesday, June 02, 2015

Why Doctors Quit

By Charles Krauthammer

About a decade ago, a doctor friend was lamenting the increasingly frustrating conditions of clinical practice. “How did you know to get out of medicine in 1978?” he asked with a smile.

“I didn’t,” I replied. “I had no idea what was coming. I just felt I’d chosen the wrong vocation.”

I was reminded of this exchange upon receiving my med-school class’s 40th-reunion report and reading some of the entries. In general, my classmates felt fulfilled by family, friends and the considerable achievements of their professional lives. But there was an undercurrent of deep disappointment, almost demoralization, with what medical practice had become.

The complaint was not financial but vocational — an incessant interference with their work, a deep erosion of their autonomy and authority, a transformation from physician to “provider.”

As one of them wrote, “My colleagues who have already left practice all say they still love patient care, being a doctor. They just couldn’t stand everything else.” By which he meant “a never-ending attack on the profession from government, insurance companies, and lawyers … progressively intrusive and usually unproductive rules and regulations,” topped by an electronic health records (EHR) mandate that produces nothing more than “billing and legal documents” — and degraded medicine.

I hear this everywhere. Virtually every doctor and doctors' group I speak to cites the same litany, with particular bitterness about the EHR mandate. As another classmate wrote, “The introduction of the electronic medical record into our office has created so much more need for documentation that I can only see about three-quarters of the patients I could before, and has prompted me to seriously consider leaving for the first time.”

You may have zero sympathy for doctors, but think about the extraordinary loss to society — and maybe to you, one day — of driving away 40 years of irreplaceable clinical experience.

And for what? The newly elected Barack Obama told the nation in 2009 that “it just won’t save billions of dollars” — $77 billion a year, promised the administration — “and thousands of jobs, it will save lives.” He then threw a cool $27 billion at going paperless by 2015.

It’s 2015 and what have we achieved? The $27 billion is gone, of course. The $77 billion in savings became a joke. Indeed, reported the Health and Human Services inspector general in 2014, “EHR technology can make it easier to commit fraud,” as in Medicare fraud, the copy-and-paste function allowing the instant filling of vast data fields, facilitating billing inflation.

That’s just the beginning of the losses. Consider the myriad small practices that, facing ruinous transition costs in equipment, software, training and time, have closed shop, gone bankrupt or been swallowed by some larger entity.

This hardly stays the long arm of the health care police, however. As of Jan. 1, 2015, if you haven’t gone electronic, your Medicare payments will be cut, by 1 percent this year, rising to 3 percent (potentially 5 percent) in subsequent years.

Then there is the toll on doctors' time and patient care. One study in the American Journal of Emergency Medicine found that emergency-room doctors spend 43 percent of their time entering electronic records information, 28 percent with patients. Another study found that family-practice physicians spend on average 48 minutes a day just entering clinical data.

Forget the numbers. Think just of your own doctor’s visits, of how much less listening, examining, even eye contact goes on, given the need for scrolling, clicking and box checking.

The geniuses who rammed this through undoubtedly thought they were rationalizing health care. After all, banking went electronic. Why not medicine?

Because banks deal with nothing but data. They don’t listen to your heart or examine your groin. Clicking boxes on an endless electronic form turns the patient into a data machine and cancels out the subtlety of a doctor’s unique feel and judgment.

Why did all this happen? Because liberals in a hurry refuse to trust the self-interested wisdom of individual practictioners, who were already adopting EHR on their own, but gradually, organically, as the technology became ripe and the costs tolerable. Instead, Washington picked a date out of a hat and decreed: Digital by 2015.

The results are not pretty. EHR is health care’s Solyndra. Many, no doubt, feasted nicely on the $27 billion, but the rest is waste: money squandered, patient care degraded, good physicians demoralized.

Like my old classmates who signed up for patient care — which they still love — and now do data entry.



Chartmanship and the jug man

Leftist economist Krugman is well know for being able to find somewhere support for most Leftist causes.  Below we see he uses a well known chartmanship technique: carefully choosing the beginning and endpoints of a series.  You can "prove" almost anything that way. It's a technique much loved by Warmists

Someone sent me an email this evening with some details on the Paul Krugman response to James Montier which I discussed here. I had previously stated that the Krugman response was lacking meat. But it’s actually worse than that. It’s actually highly misleading and appears intentionally so.

In the post Dr. Krugman tries to show how much interest rates matter by comparing the Fed Funds Rate with Housing Starts. He shows a chart and declares that there appears to be a strong correlation. Except, as this emailer notes, he appears to have shifted the chart to make it appear as though there’s a correlation where there isn’t one. Here’s the Krugman chart:

And here’s the version that would have originally shown up when the data is pulled from FRED:

See what was done there? The period in the early 1960’s was removed and so was the period from 2000 on. In other words, out of a 55 year time period Dr. Krugman decided to remove 20 years worth of data because it fit his argument better. For those keeping track that’s removing almost 40% of an entire data set just because the data didn’t fit the narrative. And when you add those years back in you get a result that shows a very weak correlation

I can understand why he might remove the period from 2008 on. But why remove the 1960’s data and the early 2000’s? After all, the 2000’s were the period of Alan Greenspan’s famous “conundrum” where interest rates appeared to have no correlation with the housing market.  That’s not just an important part of this discussion, it’s a critical part given that it includes the housing bubble and is outside of the mythical Liquidity Trap era….

This is why people often complain about economics. When economists take a data set and just blatantly alter it to fit their argument it doesn’t do much to help build credibility for their work. Especially when you do it within a post that basically declares economists are smarter than everyone else who says they might not have the whole world figured out.

SOURCE. ("Krug" is German/Yiddish for "jug")

There is a  new  lot of postings by Chris Brand just up -- on his usual vastly "incorrect" themes of race, genes, IQ etc.


For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated) and Coral reef compendium. (Updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on A WESTERN HEART.

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