Tuesday, July 23, 2013

Boyd's MegaRant Concerning Healthcare Reform - Part 2 - The Consultants

The consultant for a hospital for which I was working, briefly, introduced himself as an expert in Evidence Based Medicine. The $10,000 in fees, plus travel and lodging expenses the hospital paid, I should guess, made him the happiest of all men. In exchange for this handsome sum he was to provide us department directors a two day seminar, which will provide us with tools we can use to promote a "new paradigm in the management of patient care to meet the challenges of the Affordable Care Act." Sadly, or not unexpectedly, there was not a physician or front line nurse in the room.

This "new paradigm" is summed up like this: Hospitals must learn to use the evidence they see before them to diagnose and treat disease and injury.  Ahem, wait, were we NOT doing this? If not, what are we doing?
 This evidence should include feedback from the patient, the patient's family, the technology we use to measure anatomical processes, the electrical signals from the heart, displayed as an EKG; the microscopy used in automatic urinalysis that shows the chemical make up of what leaves the kidneys;  the sodium and potassium levels in the NaK pump within our cells; the black and white (and more frequently) color images from various xray scans which show the internal workings and health of our structures and organs. All too often, the gentlemen said, physicians rely on things akin to trouble shooting charts to determine diagnoses and treatments. They use it like this:

The patient has a rash, a headache, no fever. Look up rash, headache, no fever follow the column over, okay she must have this. Now look up the disease, she MUST have, and prescribe one of these medicines. Have a nice day! (I have yet to run across a physician I've used that actually says Have a Nice Day after he gets done prodding you and making up illnesses for you, so consider this poetic license to show the the doctor's thought process has concluded and you no longer occupy an iota of memory space in his brain.)

Then there's the docs who make frequent use of WebMD and Google (or Bing) to diagnose and treat you.

Another disturbing trend in healthcare is the number of specialty physicians. There is a prevalent myth amongst many of us, that the best thing for us when we think we have something wrong with us is to see a specialist. Here's the deal. A dermatological specialist, has a basic education in general physiology, which may, or may not, be sufficient to begin with, but has spent the last 3 to 4 years learning, in specialty, about the skin. He then diagnosis what is wrong with your skin. He also prescribes therapy based only on his special knowledge of the skin and what his books tell him to prescribe for your current problem. Unless you find the rare "holisic" thinking specialist - holistic as I use it here means "taking in the whole" body and all of its processes and functions and how it affects the skin - this doctor will not even pursue, based on other evidence, what may be causing the skin to be in the condition it is in. For instance, he may treat just the skin, but ignore, because of ignorance, or because he doesn't really care, how one's digestion, diet, lifestyle, or body chemistry is manifesting itself in the boils, fungus, blotches, or acne displayed by one's skin. If you doubt, think about a time you've had a particularly difficult to get rid of condition, when you've been from specialist to specialist and they all run the same tests, get the same results, and frequently prescribe the same medicines in larger and stronger doses. If you've been through this, you are the victim of what I call Specialist-Troubleshooting Guide Medicine. Now the juxtaposition. Evidenced based medicine will take into account other evidences that may be leading to your condition. We should be worried. First of all, because this happens much too frequently. And secondly because hospitals, are spending your deductibles and the 20% you still owe on your last hospital visit to train their staff on something they describe as the new thing in medicine. Evidenced based medicine.

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