31 July 2013

The Destruction of Medicine

In my previous blog, I covered some of the problems doctors have in working through emotions and being human with patients. In this, I am now concerned that technology is being rejected by doctors because of the poor experience many are having with electronic medical records (EMR) or electronic health records (EHR).

In this case, I fear that we have an elitist doctor trying to make other doctors feel unimportant. Why else would he promote replacing clinicians with algorithms? Yes, we have doctors in diabetes doing just that and claiming that their algorithms are very comprehensive. So why did they need to issue a consensus statement to clarify the algorithms? I'm betting because they realized that doctors were not going to pay attention and ignore their precious diabetes algorithms.

Eric Topol is the Editor-in-Chief of Medscape which published his own article. The Creative Destruction of Medicine, named for the book he wrote, says, “I'm trying to zoom in on critical aspects of how the digital world is creating better healthcare.”

Now, if he is saying that algorithms and other digital applications will become tools to aid doctors, he is on the right course. Doctors that refuse to adapt and ignore useful tools are making life more difficult for themselves and their patients. There are some extremely useful tools now available, but they have not gained wide acceptance or use. The FDA has approved some and is working to approve more, but this is more time consuming than many are aware of to insure the accuracy and safety of these tools.

One type of tool is available to monitor patients' hearts. But this requires a monitoring center to monitor the device and report heart irregularities to the right doctor. Many doctors are not using this because CMS is not properly reimbursing for the time involved. Maybe the “chronic care fee” will make more use practical. Many devices are of the remote patient monitoring (RPM) type and this may also make them more useful and practical.

Dr. Topol is not one to avoid controversy, but he does list some tools that may make doctors more efficient. Hospitals are another question, as they seem interested only in expensive and complicated equipment, not tools that will increase efficiency. The tools presently available are efficient and do their tasks remarkably well. This is just the beginning and it is still threatening to physicians.

It may be that with more efficient physicians, the physician shortage may not be as severe as originally thought. Physicians will need to adapt and their practice will definitely be more demanding with them relying on people using the tools and the monitoring centers moving to the “medical home.” In other words, the doctor's office of today will be different from the doctor's office of tomorrow.

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