All true, and applicable in that most fundamental of human qualities, the ability to bond with other people... Etc.

But studies show that for an ever-growing number of conditions, machines are providing better diagnoses than are human doctors.. For an ever-growing number of conditions.

You and I may be old enough that we'll lose this race to the next sustaining tier of social achievement. But that's how technology works... Looking back, had it happened just a few years later, all the old people who passed away in your family could have been cured of everything.

I'll always wish that your great-great-great-grandfather had lived long enough to ride in an air-conditioned automobile. And will always wish that he had known the pleasure of driving on a safe, modern freeway.

Machines may do that, but right now, practice standards can be really damaging to patient care.

Wait'll you hear about the billing!

It's impossible to find out what things cost. They give you an "estimate," but they say it can go up. Really? Like $5 or $500? It's a deterrent to people getting care, and I'd be shocked if that were entirely un-thought-out or unintentional.

In order to file a claim for medicare, the doctor must fill out a form with the diagnosis. There are over 100,000 categories, some very specific. Most people don't even have that big a vocabulary. There are still diagnoses that are not in it which can get the doc in trouble, as can checking the wrong box. The only defense is to have a group practice with special staff to fill out these forms.

Filling out the forms in the office prevents the doc from keeping eye contact and from asking relevant questions. Is ok if you have a cut finger, but if something complicated, not.

> It's impossible to find out what things cost.

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Exactly

Government regulation definitely helped drive a few nails in the coffin, but reality was hammering away as well.

Germ theory only gained widespread acceptance at the beginning of the 20th century. Medical schools then were not using the science-based curricula we expect of such schools today. They were havens of quack remedies, outdated theories, and homeopathy.

That doctor hanging a shingle out on his front lawn in Norman Rockwell America was generally not Marcus Welby, able to cure what ails you with a simple diagnosis and modern medicine.

Prior to circa 1918, your shingle-hanging doctor most likely had just finished with an apprenticeship (no medical school) and was still bleeding patients with leeches. He used the techniques of his mentor, also an apprenticed sawbones, and not a science-based practitioner.

Doctors were called "sawbones" because surgery was the most-often prescribed cure. Anesthesia was, in those days, simply knocking the patient out with an unregulated drug and hoping he didn't die or wake up too early.

In the movies, they always slip a mickey into someone's drink and it knocks them out right away. Well, that ain't how it works. Different metabolisms, body densities, weight, etc. mean what works on one does not even phase another. Anesthesiology is now a science unto itself; and the old way of simply pouring ether down a patient's throat until he slept was a good way to kill him.

Snake oil salesmen toured the countryside peddling remedies that were as dangerous as the conditions they were reputed to cure. People bought these remedies to avoid surgery, which often left people disfigured, infected, in pain, or dead.

Today's independent medical practice requires knowledge and technology - neither of which is cheap.

Marcus Welby may have died at the hands of insurance billing adjusters, but he was already sick when they killed him.

It is only hard to find out if you aren't the one paying. Go into an urgent care facility. Say you are paying cash. They can get you the right price in a few seconds. On the other hand if you are using insurance or medicare to pay for things then things get complicated.

As for the argument that electronic medical records will improve patient outcomes, that's been pretty clearly disproven. Not that it matters. The whole point was to make third party billing easier. The patient care stuff was a weak lie.

Machines may do that, but right now, practice standards can be really damaging to patient care.

Amy Alkon at December 30, 2018 6:25 AM

Well quite frankly, the doctor didn’t have the time or inclination to read thru your printed patient history and lab tests before either.

I’m pretty happy with the computer highlighting wild swings in the numbers from tests to test, so it gets called to my attention, if not the doctors.

You are still the best manager of your own care. Please don’t be stupid enough to outsource that responsibility to your doctor, a computer, or the government.

As for the argument that electronic medical records will improve patient outcomes, that's been pretty clearly disproven. Not that it matters. The whole point was to make third party billing easier. The patient care stuff was a weak lie. ~ Ben at December 30, 2018 9:11 AM

One thing I always like about having Kaiser, back when I was in NorCal, was that all my records were right there on the computer for the doctor. He didn't have to wait until the lab mailed the results to him or try to interpret some tech's chicken scratch.

Now, to Ben's point, what he did with that information was limited by his own abilities as a doctor. That they were available to him immediately did not suddenly improve those abilities.

Still, I found it better than the alternative.

You are still the best manager of your own care. ~ Isab at December 30, 2018 9:51 AM

This.

Rely on the advice of experts, but manage the process yourself.

You have forgotten one of the key features of Obamacare: your treatment may be countermanded by someone who has never seen you. This is already proven in the painkiller issue.

There's a hospital near here, Aiken Regional Medical Center. When a county or city police officer is shot, he is transported 20-something miles away, to a hospital in Augusta, GA. I suggest you may not wish to use their services, either - but bureaucracy is not about YOUR choice.

Never miss the depressant bureaucracy forces on the idea of customer service.

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Of course, if you wish to decentralize these things - because big facilities are naturally farther away from their customers - just use this model to return most transactions to the customer.

Let the customer decide if he wants to go to WalMart.

There is a crisis of physicians (a physician shortage), but also a crisis of part-time physicians — one that is about to be exacerbated by the increasing feminization of the field.

I don't have a problem with electronic records in general Conan. Heck, the fact that electronic datasheets are all now PDFs is great. Digging through all that paper was worse. But the fact remains that the legal requirement for physicians to use electronic records wasn't about improving patient outcomes. It was purely about billing shenanigans and to a lesser extent about generating large data sets for government statisticians to play with.

Back when you were with Kaiser was that their choice or one the government forced on them? There is a world of difference between the two.

As CC mentions, you didn't used to need a specialist to fill out the paperwork. That brings nothing of value to either the doctor or the patient. We aren't talking about the differences between now and 1900. We are talking about now and 2000. Medical schools and germ theory didn't change much between those two dates.

One of the reasons that medical costs are high is that every doc has to do a residency and the fellowships for residents all come out of a federal government budget. ie it is rationed.

Another cost is that many localities have a requirement for a "certificate of need" if you want to buy an MRI machine. They have this fantasy that too many facilities will raise costs because the machines won't be utilized enough. This is backwards of course. It is simple restraint of trade. In places without such requirements costs have come down for such lab work.

They have this fantasy that too many facilities will raise costs because the machines won't be utilized enough. ~ cc at December 31, 2018 8:35 AM

Marx had this same fantasy, an obsession about efficiency, excess capacity, and government regulating the use of productive capacity. Having too many manufacturers of a single product was considered inefficient and to be avoided.

Competition was not considered by Marx to be a market mechanism to cull the herd and ensure the best products prevailed. Instead it was considered a flaw of capitalism, a waste of resources, which, under socialist dogma, are always viewed as limited.

"But the fact remains that the legal requirement for physicians to use electronic records wasn't about improving patient outcomes. It was purely about billing shenanigans..."

More specifically, it was about giving Medicare and insurance companies new tools to use to deny claims.

"There are still diagnoses that are not in it which can get the doc in trouble, as can checking the wrong box. The only defense is to have a group practice with special staff to fill out these forms."

Or, to hire a billing service that keeps a database of which ICD-10 codes get claims paid by which insurance companies. In other words, they are fixers. A service for which there was no market before the government got involved with deciding who gets what health care.