Fall 2007; What Have I Said So Far: Part 1

Stanley Feld M.D., FACP, MACE

Our most precious asset is our health. We should be responsible for our own health and welfare. The ability to maintain our health is dependent on access to the healthcare system for diagnosis, treatment and health maintenance. The dysfunctional healthcare system is decreasing our ability to maintain our health by limiting access to the healthcare system.

In the past thirty seven years as a Clinical Endocrinologist, I have seen many advances in the medical care system as distinct from the healthcare system. We are becoming proficient in preventing the complications of chronic disease. The complications of chronic disease consume 90% of the healthcare dollar. I have observed economic and political distortions of a healthcare system. These distortions have impeded the physicians’ ability to prevent the complications of chronic disease.

Many have declared that the healthcare system is broken. We have also heard that while all goods and services industries have embraced the electronic era (not totally true), physicians have resisted the electronic revolution. It has been stated if medical care is to step into the 21 century, medical practices simply have to adopt an Electronic Medical Record (EMR). The EMR will solve many of the healthcare system’s problems.

In my opinion, the notion that the widespread adoption of an EMR is the solution to the problems with the healthcare system is simplistic and incorrect. It is true that physicians have resisted instituting EMRs, for many good and not so good reasons.

Why have physicians resisted the EMR? It is hard to find a coherent answer in the literature. Here are some reasons.

The EMR’s are too expensive to purchase and too expensive to service. They will not help patient care in their present form. There have not been standard EMRs developed. The EMR should help the patient and physician. If past behavior is a predictor of future behavior the data accumulated by the medical care system will be misused to the disadvantage of the patients and the physicians by the insurance industry and government.

These are some of the reasons for physician resistance. The Ideal Electronic Medical Record outlines my propose solutions to the EMR dilemma. Since we do not have universal adoption of EMRs, society is led to believe that the problems with the health care system are the physicians’ fault for not adopting the EMR.

However, a sober look at the problem reveals all of the stakeholders are at fault. The stakeholders are the government, the insurance industry, the pharmaceutical industry, the hospitals, the physicians and the patients. All have played an important role in the distortions and dysfunction of the healthcare system.

In my view, the patient and the physician are the key stakeholders. Without the patient and the physician, we would not need a healthcare system. The patient is the player and the physician’s role should be the coach, making the diagnosis and teaching the player what he has to do to get well and stay well.

However, in 2007, the patient and the physician are generally listed last among “important” stakeholders by government, insurance companies, hospitals and policy makers.

Since the patient is most important stakeholder, patients should be in the forefront of policy making. Physicians should be second. Unfortunately, as physicians have adjusted to the changes in the business aspects of healthcare their ability to practice efficient, effective and friendly medical care has deteriorated.

All other stakeholders are in reality facilitator stakeholders for patients and physicians. Everything done in the healthcare system should be done for the benefit of the patient first, and not for the economic bottom line of the all the stakeholders. After all it is the patients’ healthcare system! Is it not?

The demand for repairing the healthcare system and action to fix it has to be made by the patients.

Comments

[Fred Wilson]

Dear Dr. Feld,
I'm confused. In the second paragraph you write, "We are becoming proficient in preventing the complications of chronic disease." Then at the end of that paragraph you write, "These distortions have impeded the physicians’ ability to prevent the complications of chronic disease." How does one become proficient, if their ability has been impeded?