Matt Stoller warned back in 2012 that insurers would increasingly induce, then force, customers to agree to surveillance. But a Wall Street Journal story tonight describes how insurers and medical providers, meaning your doctor’s employers, are actively cooperating, so as among other things, to help Big Pharma peddle more drugs to you.
Stoller warned that over time, insurance companies would make it prohibitive and eventually impossible to refuse to agree to intensive monitoring:
Profit-driven surveillance does not start and stop with young adults. It is, in fact, becoming pervasive. The main theme of a recent IBM consulting document on the future of the insurance industry is how much more money an insurance company can make if it tracks and tags its customers. This is particularly true for auto insurance companies, some of whom like Allstate and Progressive are experimenting on new technologies. For instance, IBM suggests that “A “pay-as-you-live” product would trade some location and time-of-day privacy data for lower insurance bills overall.”
IBM is recommending these companies stick a sensor in your car, measure where you go and when, your speed, acceleration and deceleration, etc. The progression over time could be to withdraw traditional insurance products, so that you won’t be able to get an insurance product without sensors attached. As this presentation offers, “The aforementioned rising tide of technology also empowers insurance underwriters to bring their products closer to realtime interaction via sensor networks and enlightened privacy regulations.”…
Now at least this progression has the appearance of being consensual. First you are paid for giving up your privacy, then over time, the positioning changes so that customers have to pay a premium for non-monitored products, and then as their usage falls (and you get a lot of adverse selection), the insurer can pretend to be justified in getting rid of the privacy products, having set them up to fail.
And even though far too many people are perfectly happy to wear devices that monitor some health measures on an ongoing basis, at least they chose for the data to be collected and hopefully have some appreciation that promises about privacy too often aren’t what they appear to be.
But the Wall Street Journal describes what amounts to a full bore war on individual medical privacy, including linking medical histories to credit records. And the author puts a big smiley face on this effort by depicting it as breaking down silos. “Silos” is a dog-whistle word in Corporate America. Silos are bad! Sharing is good! From the article:
Although technology exists to make AI a potent tool, there is a snag. Data relevant to answering specific questions often reside in various locations, from hospitals to diagnostic labs to pharmaceutical companies. These information silos are typical in the health-care field, leaving scientists and other medical professionals at a disadvantage to harness the full predictive power of AI.
Small businesses such as PatientMatters LLC and Prognos Health Inc. are overcoming the data-gathering obstacles to provide insights to medical customers including health plans. “For Prognos to do what we do, you need to have large data sets,” said Sundeep Bhan, co-founder and chief executive of Prognos, which helps insurers predict their members’ disease risks.
Lovely. So now we have medical pre-crime, since these data-diggers are making it sound as if they are doing more than projecting out the typical trajectory of pre-existing conditions. Again from the article:
Prognos…has teamed up with diagnostic labs to accumulate diagnostic data on 200 million patients, which it marries with information from health plans to answer questions such as which members are likely to develop a specific condition.
Diagnostic labs, which hope their data will be used to solve medical problems, share the entrepreneur’s dreams of seeing medicine take a leap forward, Mr. Bhan said. “At the end of the day, in health care, that’s what we care about,” he added.
If you believe that, I have a bridge I’d like to sell you, as the story itself demonstrates:
Prognos, which has about 100 employees, aids pharmaceutical companies’ marketing efforts by helping them identify health-care providers that have patients who could benefit from their drugs….
Companies such as PatientMatters have crafted services….aims to help health systems gauge patients’ ability to pay bills and identify financial-aid candidates.
PatientMatters, based in Orlando, Fla., and formed in 2012, analyzes medical information from clients as well as publicly available financial data from credit-reporting agencies and other sources…
Increased use of high-deductible insurance plans means health-care providers must collect more of their revenue from patients. By gathering data and applying AI and machine learning, PatientMatters, which has 235 employees, can help clients anticipate people’s payment behavior…
The article describes how the data hounds have had some success in getting hospitals to hand over emergency room data as well as medical images.
How much of this will wind up being a garbage-in, garbage out exercise? Most of this data is presumably from electronic health records. We’ve regularly published cross posts from Health Care Renewal on this topic, describing in depth what a train wreck they are. The short version is that EHRs were designed for billing purposes, not with medical care in mind. Two of many examples: Health Care Information Technology: A Danger to Physicians and to Your Health and How Electronic Health Records Degrade Care and Endanger Patients.
How much has Obamacare with its neoliberal shopping imperative, undermined this data gathering and mining? In theory, if you have opted to be in an HMO, all of your records ought to be under the same roof. But what if thanks to Obamacare, you switched HMOs, or went from an HMO to a PPO and then back, or even went without coverage? Your medical records are supposed to go from your old provider to the new ones, but how often does that happen well? I know of people who insist on getting copies of all of their blood and other major tests to carry with them to doctor visits, since they’ve found too often the doctor either doesn’t have all of the information or doesn’t have ready access to it.
How much will this effort be used to further corporatize care and reduce doctor input? It is a safe bet this sort of data will be used to advance the corporatiation of medicine, which we first discussed in a 2013 post, citing Dr. David Edelberg at Whole Health Chicago (emphasis original):
• The health industry hopes that individual medical practices and small medical groups will ultimately disappear from the landscape by being financially absorbed into larger groups owned by hospital systems.…
Physicians are expected to spend a limited amount of time with each patient, and are encouraged to see as many patients as possible during a workday. The insurance companies, sometimes with the token cooperation of a few physician-employees, create vast books of patient-care guidelines to which they believe their physicians must be “accountable” (remember this word, it will crop up again). These guidelines might mean documented Pap smear and mammogram frequency, weight management and exercise, colonoscopies for patients over 50, and getting that evil LDL (bad cholesterol) below 99 by any means possible…
If the chart audit system discovers that a physician, for whatever reason, is an “outlier”–that she’s either not following the guidelines exactly or not getting the results anticipated for her patient population—she’ll be financially penalized. A quick example of what might occur: if your LDL is 115, you may be on the receiving end of a statin sales pitch from your doctor, not because bringing it down to 99 will improve your longevity, but because your refusal to do so will impact her financial bottom line….
…the subtext of “standardized” always includes the unspoken “spend less money on the patient.” Thus, a doctor might be financially penalized for recommending nutritional counseling to lower cholesterol (“counseling is expensive”) instead of writing a generic statin drug (cheap). Or recommending psychotherapy (“therapy is very expensive”) instead of generic Prozac (cheaper than M&M’s). Or referring patients for massage, acupuncture, or even chiropractic (“expensive, expensive, expensive!”) instead of pushing an over-the-counter antiinflammatory (free to the insurance company, as it’s OTC).
And the connection to credit data is cringe-making. Just wait for the articles saying that a better credit score means better health, when if there is any causality, it almost certainly runs the other way.
There’s an even more immediate possible use for this information, as Wall Street Journal reader Michael Heinzmann pointed out:
With the GOP hell-bent on eliminating protections for patients with preexisting conditions from guaranteed access to health insurance – any leakage of personal/private healthcare data would have devastating effects upon millions of patients. Healthcare organizations have a very poor track record on protecting their customers’ data (and none have suffered any significant sanctions).
Even thought I am pretty well insulated from this data hoovering by a combination of happenstance and habit, it makes me very uncomfortable to know it is going on, particularly since I won’t be able to continue to be a refusnik once I reach Medicare age unless I become an expat, which is likely to be too high a hill for me to climb.
And if you think these concerns are overwrought, please read a Financial Times article Lambert flagged yesterday, a review of Shoshana Zuboff’s The Age of Surveillance Capitalism. A key section:
Although Zuboff is a professor emerita at the Harvard Business School, her account is as much polemical as it is academic. She is determined to awaken our sense of astonishment and outrage about how this rogue capitalism has evolved to dominate and degrade our lives, largely unnoticed and unchallenged. She also makes one other more worrying and highly contentious claim: that surveillance capitalism has created a new kind of unaccountable power: instrumentarianism. She defines this as the instrumentalisation of behaviour for the purposes of modification, prediction, monetisation and control that threatens to challenge some of the functions of the state and usurp the sovereignty of the people. Instrumentarianism can determine the ends, because it can manipulate the means.
Zuboff warns the state won’t do much to stop this trend, because it is often a beneficiary and co-conspirator. So it falls to us to throw sand in the gears when we can.
Actually this could get a lot worse and I don’t mean a sensor shoved up the kazoo. I have wondered for a long time that what if these insurance companies demanded that all of their ‘customers’ submit their DNA to get good insurance. You will still get it if you don’t but it might cost you an extra grand on your premium because you are so ‘selfish’. After all, sharing is caring, right?
Then, after testing the DNA, they might say that they won’t insure you for heart conditions on your file due to a genetic predisposition for heart problems as an example. In the long term, as you won’t be able to get insurance for what you might actually get, an insurance policy in the future would really only be for accidents and medical conditions that were unlikely.
We are seeing the same sort of garbage in Australia. Years ago they launched a public health record that was voluntary. I refused because I knew they launched it without the security protocols in place. Then last year they made it compulsory but that you were allowed to opt out. A million have done so already and they keep on having to push back the opt-out date but this My Health Record is already experiencing problems. Bah! Humbug!-
I wonder as well if this will also encourage US employers to demand that potential and existing employees sign a waiver allow their employer access to their medical data in order to keep them off of the health plan or terminate them for being too expensive to ensure. They could then conduct a background check with past health insurers who would probably be more than happy to tell them about your medical history and expenses incurred. To be fair, I am not sure if even the At-Will doctrine allows for obvious medical discrimination. The problem is that if employees are basically being de-facto forced to sign said waivers as a commonplace practice of working for most companies they would most likely be in no position to refuse as if they did they would likely be out of a job.
HIIPA violation at least. Surely would be teste in the High Court.
Yet we can’t even get every employer to use E-Verify?
I worked for the federal government when myGov was launched. I can attest to the security vulnerabilities with that system. I’ve opted out and urge all Australians to do the same.
It’s called a health “industry”. What is the product of this industry? Not healthy people. It is profits. Just say no to health care. Embrace mortality.
Instrumentarianism…So there is a word for this phenomenon where humans need to conform to what systems and machines require. Because systems and robots cannot change, we have to. All the talk about ai and the result is always that the humans need to adjust.
I live in a small city in upstate NY. Individual practices and small medical groups have already disappeared. All doctors have become employees of one of the two corporate health care companies. The only independent left is the one urgent care practice. Since doctors became employees , I think the quality of care has declined. Doctors see a new patient every 20 minuets instead if every half hour. That means they see 8 more patients each day. Also there are more interns so you doctor will suddenly be gone and you will be assigned to another doctor. This has happened to my wife 3 times last year. Often you can’t see a regular doctor or your doctor in a short time. It may take several months to schedule an appointment with your regular doctor. The result is poor quality for the patient. The doctors are so busy they don’t have time to look over a new patients previous health records. This results in poorer quality. Health care has turned into a money making business where the patient is nothing more than a source of income.
Good comment. Health care for profit is indeed an oxymoron.
Some years ago, a general practitioner told of his insurance experience. One insurance carrier fired him because he wouldn’t accept their proto-instrumentarian approach. He fired another because they pushed for limiting patient exam room visits to SIX MINUTES. What doctor can live up to a Hippocratic Oath in those circumstances. His third insurer was marginally tolerable although that was before the joys of the ACA.
I wonder about his current views, although note that he is old enough to have opted out of the madness by retiring. He probably has company in that former doctor status which is sad due to all that medical knowledge and experience fading away.
>The doctors are so busy they don’t have time to look over a new patients previous health records.
The irony of a system whose intent is to both capture every bit of data about us and make it available to the world (of medicine, but we know it will leak out other places) and also to press said doctors so hard that they can’t really give all this info a look.
But AI! they say. Which has apparently managed to mimic only one human concept – racism. And we don’t really want human intelligence even if they could manage it, do we? Just the same mistakes on a bigger stage, but nobody will ever question the machine.
Gawande summed it up in New Yorker article, “Why Doctors Hate Their Computers.” Most salient were the comments by internist Dr. Susan Sadoughi on the garbage in, garbage out aspect. So much for efficiency.
And like your facebook posts, garbage diagnoses will clutter your “problem list” for the rest of your life, creating biased evaluations by providers who are eager to pigeonhole patients in their misdiagnoses–especially when mental health overlaps. It’s much easier to dismiss symptoms as supratentorial. That works well for insurance companies who discard what they view as human trash by ratcheting up premiums, deductibles, co-pays and co-insurance to ensure whatever insurance you can afford has no value.
A few years ago, Kaiser Permanente invited me and my son to submit DNA to their research bank. https://researchbank.kaiserpermanente.org/
The answers to their FAQs didn’t satisfy the inquiring mind of this retired doc. I sent an email with the following observations and questions and got a polite response that they would be forwarded to a manager.
Needless to say, I didn’t get a reply from the manager. We opted out of this genetic data mining.
Ah yes, yet another installment in the seemingly endless spiraling downward (from the patient point of view, anyway) of the US healthcare system. This year, I declined to endure another exponential yearly increase in the exorbitant premiums for my entirely useless and ridiculously expensive policy, and am enjoying the feeling of seeing those funds sitting in my bank account and available for spending.
I’m seriously thinking that my health will be slightly better, as I will continue to read these chapters, but with some degree of sanguinity, rather than the boiling rage and resulting higher blood pressure they used to cause me.
The real trick is how to shield that money (and the rest of your remaining seize-able assets) from the medical bill collection thug vultures if (and most likely, when) the time comes you need care.
The status-quo of this horrific system needs to be upset or I fear it will never change, and if wholesale collapse is the push that is required to do so, then bring it on, the faster it happens, the quicker things will change.
actually if only holding out until Medicare age there is a decent chance of making it there before major medical expenses hit. So it’s not as risky a bet as all that depending, but it is a risk.
I expect to be living in another country within the next couple of years.
Yves, we are all indebted to you for this post. Will Surveillance Capitalism finally bring Les Gilets Jaunes to the U.S.? That may be our only hope.
My PCP fired me for asking her to look away from her computer and listen to me. Haven’t found a new one.
Btw re Obamacare I’ve probably mentioned this before but I shut down my small business in 2017 and joined a large corporation that has healthcare benefits for my family. We do a lot of smart infrastructure stuff, buildings and cities, where instrumentalism will become ever more pervasive. We also work in healthcare infrastructure but so far due to hipaa we are not touching patient info. Our healthcare own provider wants us all to voluntarily wear their Fitbit-like wristband. At some point one can imagine it will not be voluntary.
Most scenarios that people explore are of the risk management office denying coverage (or effectively denying by setting rates too high to afford), but the other devious bunch are the marketing and sales departments. Marketing, of course, will just-in-time spam you or sell your info to “partners” at any hint of a content trigger query or data activity “signature”. The sales department will use your data and profile to provide a conman’s rationale for why your individual rate includes a special surcharge.
I saw this behavior years ago with a real estate company selling homes in a new development. I had to laugh when I noticed that every parcel had a “lot premium” charge: corner lot (prestige); middle lots (low traffic); lots with trees scenic); lots with no trees (sunnier); lots near the ingress (commute access); away from the ingress (private)…
I had to laugh when I noticed that every parcel had a “lot premium” charge: corner lot (prestige); middle lots (low traffic); lots with trees scenic); lots with no trees (sunnier); lots near the ingress (commute access); away from the ingress (private)…
Ha,ha,ha,ha,ha… I got a good laugh out of that myself… :-) Thanks!
We’re about 6mo away from airline seating hitting this threshold too.
Kind of like buying a car for the low low price of $9999, but then comes without certain items to actually run the car, like tires, a steering wheel, window glass, because hey, we’re all about consumer “choice.”
This sounds like another amazingly good reason to get a single payer healthcare system in this country. That being the only real way to de-incentivize this type of abhorrent behavior from those who wish to monetize our existence.
IBM. the company that came up with the numerical system the nazi’s would stamp on the concentration camp prisoner’s arms. Along with the corrsponding forms and machinery to catalogue who was there and why… all in the “code” those numbers were.
IBM what an “efficient” company. If they were good enough for the nazi’s, they will be good enough for the american health insurance scam.
I’m with you on instituting single payer -Medicare for All (M4A); we’re about sixty years behind the other major developed nations. There are two important points (at least) to consider.
India has Universal health care and their system reflects an issue that is already inherent to ours, and Canada’s, just to mention two nations with problems related to geographic areas far from urban centers. Medical care in remote areas deteriorates drastically; people in the rural US may travel several hours round trip to see a specialist. We could address this problem with the institution of a rapid transit system. Medical care is not really universal if patients can’t easily travel to their caretakers. This is a problem almost everywhere, not just in rural areas.
The second issue that I don’t hear many M4A activists, enthusiasts talking about pertains to the medial care standards that the Center for Medicaid and Medicare Services (CMS) already promulgates across the whole medical field.
Take a gander at pediatric care. The standards shown and many others are already used by private insurance companies, they are like “Well, we use CMS guidelines for medical care, so you should fall in line.”
Using one set of standards for medical care and expected outcomes is a good thing but realize government bureaucracies are recalcitrant in moving in new directions. Once a bad policy is out there, try, just try, (and your little dog too) to get it changed. Again, I fully support M4A and how hope to see it instituted. I am an activist for reforming Medicare and Medicaid so that every one gets the right kind of care when they need it. Then we may look forward to the day when the quality of outcomes improves as well.
Having access to that care is very important as well.
if i did not submit to the MRA exam by my employers health insurer, my premium would be doubled.
As a part of the fineprint, the results of the MRA would be disclosed to my employer and “operational reasons”.
Given that the health insurance is a major reason to be employed, i do not have a choice.
I remember any disclosure of patient healthcare matters from the insurer to the employer used to be prohibited.
It is difficult to have a neutral or rational discussion about the significance of
creepingrunaway privacy invasion by corporate/financial interests (and supported by government and media acquiescence if not collusion). All too often it is an uncomfortable subject that raises (media supplied) alarm bells such as “conspiracy theorist” or charger of wind-mills. Raising concern – or trying to – can quickly become self defeating. Perhaps also, so many people are just plain good natured and don’t like to contemplate our darker sides.
It isn’t completely hopeless. I’ve been surprised recently by a sense of greater awareness. But generally, and particularly the more insidious aspects of privacy erosion/collapse remain a complete “back burner” to other more pressing issues.
And some even like it. They are flattered or comforted (or something) that at least someone takes an interest. Poo-pooing privacy concerns seems particularly well suited to the phenomenon of lobster pot acclimatization. It’s all good until suddenly it isn’t.
I also would argue that the erosion of privacy and particularly the lack of concern for privacy, is an excellent barometer of the late Satyricon stages of depravity “empire collapse” is entering.
I was talking to my millennial son about this last week. I was complaining about google listening to me on my phone and sending me ads about my conversation. He laughed, said tell me something I don’t know. That’s the way the stuff works and his friends completely understand. I sat perplexed by this, but kinda got to the place where to them, this like electricity and smokestacks. Yeah one sucks, but you can’t have the other without it.
Another reason to pay with cash when purchasing items insurance companies don’t like. Mastercard is selling detailed credit card purchase data to insurers.
Mastercard has only the vendor name and date and the amount of the transaction. They don’t have anything more than that. If you see your MD, they don’t know why or what services he/she provided. And if you buy ice cream and cigarettes at your grocery store, they don’t see that either. And if have a charge from a wine store, how do they know if it was for you or for a party or for a gift?
m4a would at least lower the profit expectation that pervades every aspect of the health industry and motivates it’s workers, and also these are the right wing dems and their left wing republican counterparts that oppose any attempt to rein in the profit. Can I say welcome to your libertarian future?
Having sat across the table from Technology companies for decades, I can think of no worse candidate for taking over healthcare or really any kind of insurance than IBM. They are proprietary, customized, dependent upon a constrained market of skills, expensive in both the short and long term. The banks would flee from IBM’s mainframe technology if it were only humanly possible to do so. If it does eventually work as it’s intended there was a better solution you should have invested in that has blown past them in the market.
Watson is not a great AI engine. It has a great NLP interface that sells execs. It’s highly dependent on the structure of ingestion that can only be done over long periods of time by a handful of the brainiacs that work on it. They charge monster fees for ingestion and POC’s, won’t commit to future pricing unless you sign some monster board level deal and their contracts basically say they’ll do their best at whatever the customer tells them to do. They’ve spent 10’s of millions (at least) kitting out an office floor in NYC where they walk Exec’s, usually the ‘chosen sponsor’, through a maze of floor to ceiling video game simulations of fixing all the world’s problems. This is not hyperbole, that is exactly what they do. That’s how they sell Watson, and let me tell ya, people buy it. Then they are disappointed and they are stuck having spent a fortune on a POC and training their team how to do it, or worse, the monster deal.
In the meantime, there were better ingestion tools, better AI algos and better NLP solutions if an AI solution is really what you needed. Most of the actual Watson solutions I saw were exponential overkill where half the cost of the POC would have put a workable solution into production.
I could write a thesis on these guys. 50%+ of their revenue is recurring. Cost of sales is in the low 20’s, R&D is 2-3%. They spend 10 times more to sell you 45 cents on the dollar then they invest in R&D. The point is they are a horrific choice to reinvent society. Oracle is right up there as well. The Ellison / Musk stuff was laughable, but that’s a different topic.
Marketing, all innovation has been lost to marketing. Time to eliminate pharma marketing, hospital marketing, why I have to get a fancy magazine every quarter from the only hospital in my town is beyond me. The billboards need to go too.
Boeing has a room like that in Arlington that they use to sell the pentagon brass on killing machines.
Assume an insurance company creates and continuously improves a predictive risk analysis tool. As the effectivity of that risk analysis tool approaches 100%, wouldn’t your policy cost be equal to the cost of the predicted claim? (plus the insurance company’s administrative overhead)
CNBC’s Chrissy Farr asks “given all the digital health infotech investment, why are we no healthier?”
Perhaps because improving health care outcomes is not a goal of that infotech investment?
Is this Taylorism?
I think this comes from the same desire to control everything and not necessarily increase “efficiency” or profit. It is also the neoliberal crappification of everything by using cost cutting instead of improvement to make more money.
Taylorism, much like the extreme work hours that use to be in factory work, is way to control, dominate, and pacify the workforce. The American auto companies used similar techniques in the 70s in an effort to avoid all those pesky union workers demands, which including ways of improving the manufacturing of cars, but instead using high tech automation and computerization; Japanese automakers put their efforts into improving the workers’ efforts by involving them and not into controlling them via mechanization.
It would make an excellent master’s thesis to compare GM’s throwing away their well trained and educated workforce’s talents and desire to do well because of their troublesome independence and with Toyota’s integration of their workers and management into constantly improving their manufacturing; the American auto industry did not trust their workers or want their input while the Japanese do. This process also carried into the quality of the individual auto parts, although the Japanese companies have edged into this, the Americans went into crapifying their parts to make more profit decades ago.
Weirdly enough it was from America after the Second World War that the Japanese learned the techniques needed to succeed while the Americans discarded them.
Could someone please provide a link to the WSJ article?
Sorry put links in the post.
Would all of this be solved if the profit motive were removed, by enacting Medicare for All ?
Or would it be important to maintain medical records privacy from the government, too ? Because, if so, you know that will be the last-ditch appeal to stop M4A from happening.
What is IBM doing with Watson Health?
https://www.wsj.com/articles/ibm-positions-itself-as-large-broker-of-health-data-1428961227 (behind the paywall)
Note he said “typically” anonymized.
A link found via one of yours:
“We’re all suddenly willing guinea pigs,” says Matt Stempeck, the 31-year-old director of civic technology at Microsoft (MSFT), a position that didn’t exist a year ago. “We all want to be part of the experiment these days.”
Self-serving corporatists selling *everyone else* out…
Noticed the other day Home Depot now has scanning gear at their self check out that ONE MUST FRIGGIN TOUCH! Before the scanners were built in like most every other biz with self check out so there was nothing to touch besides one button.
My theory is this:
Big Pharma: So, (redacted), we noticed you have self-checkout.
Since we both know exactly who is in the store in real time – how about we pay you to put in scanning gear that maximizes the sharing of contagious bugs so we can push some mobile ads to the contagious “sick” people are sharing at the self check out.
(Redacted): Do we get a cut of the drugs you sell to our customers then?
Big Pharma: Sure, why not.
(redacted): We’re in!
At Home Depot, if it’s not too busy, go to the checkout with a human. At least where I am, they still have the old style card readers with a non scanning physical button. If I must use the self checkout, I put a piece of paper (one of the plastic checkout bags works) between my finger and the input screen and usually that works. If not, I ask the person in charge of the machines to push the button for me. I actually don’t think the reader scans for finger print (yet) – I think it does, however, check the temperature of the object touching it for whatever reason. But that doesn’t mean it won’t be capturing that data soon. They already post that they actively monitor customers on cameras so I imagine they will hook that up to FR soon enough if not already.
While they still frequently have good help with real domain expertise, some of the products are taking another dive in quality. You have to pay attention.
Thank you so much, Yves, for starting this discussion. Responding to the statement: “The health industry hopes that individual medical practices and small medical groups will ultimately disappear from the landscape by being financially absorbed into larger groups owned by hospital systems. Physicians are expected to spend a limited amount of time with each patient, and are encouraged to see as many patients as possible during a workday.”
A friend of mine, a psychiatrist, has this as his email tag line (emphasis is mine): “Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.“ — Dr. Francis W. Peabody, 1926, speech to Harvard Medical School students.
Lots of things I would like to explore or see explored.
There are a couple of trends here that I am curious about. First is captured quite well by all of this discusion that there is certainly a quickening industrialization of our [Americans’] health care. People are becoming less the patients and more the widgets moving through the machinery of our health care factories (aka hospitals). Because providers are incentivized by insurance and managers for throughput and protocols, there is less and less actual care going on.
Then, the amount of money we pay for our health care (mostly through insurance companies) certainly hasn’t led to more money going into providers’ (and their employees) pockets. It seems like the labor market for the workers who actually get people better isn’t thriving like it should if there is all this money. I make this hypothesis because I feel like people are not yet jumping into training programs to learn everything from health care clerical work to medical technicians to physician assistants to licencsed providers. Are the barriers to entry too tough, or is the incentive just not there, or is there something else?
Related to this is my next question. Do we have a shortage of providers? If providers are forced to reduce their patient contact time to the level of six minutes, with some of that spent tapping into a computer, there’s no way a provider can actually care for a patient. If providers are becoming so scarce that this is what they must do to address our nation’s health needs, we have to find other solutions.
In the US Navy, most ships don’t have physicians on their crew. They have what’s called an independent duty corpsman (IDC), who is an enlisted Sailor, trained, but to a level even less than that of a nurse or PA, but more than an EMS tech. They administer under a certified doctor’s license for up to 200 people. Granted, Sailors tend to be a fairly healthy cohort, but can still get sick, break bones, pull out a back, etc. And those of older Sailors have repressed medical needs that do tend to crop up later in our careers, and we need specialized care, so their task isn’t without challenge. Every Sailor I know prefers the care they receive under their IDC over that of any other provider. It amazes me that these IDCs, with minimal trianing can provide such a personal level of care and health care management. They are charged with, and to an amazing record achieve, maintaining their crews fully ready to deploy thousands of miles away from medical facilities for months on end. This requires thousands of administrative actions per year, a really good generalized knowledge of medicine and, most importantly, knowing and actually caring for their patients.
My experience in the Navy begs the question of where we should be taking the US health care economy in the coming future.
This morning I was in a Starbucks waiting for my meeting to start when I heard a nurse at the next table making phone calls.
“Hello? (NAME OF PATIENT)? This is ____ from the office of ____ calling about your HPV screening. Yes, it was positive, yes I’m sorry. Yes. Terrible.
I’d like to sign you up for our educational program.”
So much for HIPAA
That’s nothing. I was waiting for my wife to get her blood drawn in a Q***t diagnostics lab.
The overworked and stressed out phlebotomist, who was also the receptionist, the only person working there, had left the answering machine volume all the way up.
All the twelve or so people sitting in the waiting room got to listen to each incoming message, i.e.
“Hello, This is Mary XXXXX, I’m calling for the results of my syphilis test. My phone number is…”
Never went back there again. Now they are buying up every independent lab around here.
That is an egregious privacy violation. Please report this to HHS for the sake of those patients. Include as much detail as you remember about the nurse (a physical description and the name he/she identified himself/herself as on the calls), the patient names, contents of the phone calls you overheard, location of the Starbucks, and date and time. It doesn’t matter if you aren’t a patient yourself or related to a patient. They do investigate and follow up on these complaints (though the shutdown will likely cause delays).
Is this a critique on sharing health records between medical practitioners or a critique on the current health insurance industry? I can see life saving advantages of the former while the latter is a reflection on what the US healthcare system has digressed into. Under a system that provides universal health care, data sharing can be beneficial in many ways.
” it falls to us to throw sand in the gears when we can.”
Clogs???…in the cogs???