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Are Medical Guidelines Helpful? They are to drug companies. Unfortunately the cholesterol, diabetes and other medical society groups' committees that write the medical guidelines are so dominated by doctors on the drugs companies' payroll that the guidelines may do more harm than good. This is supported by a new study which found: "If guidelines are universally ignored, their impact on treatment and outcomes is minimal. Certain patients may be harmed by adherence to specific guidelines." (Read more.)
This week, I would also like to continue our discussion of the Health Care Reform plans promoted by our two excellent presidential candidates. This week, let's start with the issue of wasted health care dollars. As a physician who has practiced 30 years, I find our system to be incredibly inefficient—starting with both the time wasted on unnecessary paperwork, and the money wasted on repeat testing that occurs because old records are not available. In addition, computers can create most of the patients' medical record before they even see the physician, effectively gathering information entered by the patient. It can even analyze the information, allowing it to recommend the doctor consider certain tests and treatment options. As physicians now have only about five minutes on average per patient visit (which is another medical disaster), a computerized "physician's assistant" can free up the physician's time so they can actually listen to the patient, and then teach them and answer their questions.
If the idea of a physician's assistant computer program seems unlikely to happen, I am happy to note that it already has. I created and patented one years ago which I, and many other physicians, use for patients with CFS and fibromyalgia. These incredibly complex patients require over an hour simply for records review and review of their history. The computer program creates a complete medical record (except for the physical exam) of the patient's case, and analyzes the symptoms and labs to determine the probable contributing diagnoses. It also tailors a treatment protocol to that patient's case, supplying detailed patient instructions. It includes a detailed screening for cancer, and other medical symptoms that can be live saving when caught early, and is easily filled in online by the patient at home. This allows the physician to use their time to properly care for the patient, and allows even new physicians the benefit of the expert's experience in each specialty and illness.
So let's compare our presidential candidates' plans for bringing medicine into the 21st century using the power of computers:
Barack Obama’s Plan for Using Electronic Heath Information Technology:
"Lowering costs through investment in electronic health information technology systems—Obama and Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT. Obama and Biden will ensure that patients' privacy is protected."
By my reading, Obama’s plan:
1. Clearly notes the issue—Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims.
2. Clearly states how he will address the issue—“Obama and Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT.”
In addition to sounding good, these words actually suggest a familiarity with the technical issues involved. Obama and Biden will ensure that patients' privacy is protected.
John McCain's Plan for Using Electronic Heath Information Technology:
"INFORMATION TECHNOLOGY: Greater use of information technology to reduce costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines."
By my reading, McCain’s plan basically says "yes, we should do something," with no real plan. Sadly, I find much of his health plan in general to be very weak on the details. Even worse is that his key statement is about "technology that allows doctors to practice across state lines." This is a meaningless statement as it is the state medical boards which determine who can practice in each state and thus across state lines—not the technology. This suggests to me that the candidate is very weak in his understand of what is actually occurring in health care—causing his "weak on details" problem.
I invite you to read each candidates health policy at their own websites:
Barack Obama's Health Care Policy
John McCain's Health Care Policy
In addition, if you are a health practitioner or are involved with setting health policy, I invite you to read An Open Letter on Health Care in the 2008 Presidential Election to see what other physicians think about the candidates policies.
