I rarely do follow-up columns. I'm averaging one every 10 years. And while my last such exercise resulted in a written apology from the White House (for accusing me of making up facts over its removal of Churchill's bust), today's is not a complaint. It's merely a recognition that the huge response elicited by last week's column, "Why Doctors Quit," warrants both rebuttal and clarification.
Physicians who responded tended to agree with my claim that doctors are being driven out of the profession by the intrusions, interferences, regulations, mandates, constraints and sundry other degradations of their vocation that are the result of the bureaucratization of medicine. Chief among them is the imposition of electronic health records (EHR).
I've also heard from people who notice how much attention their doctor must devote to filling out EHR boxes on a computer screen rather than to engaging with them during an office visit. To the point where a heretofore unheard of profession has been invented -- the "scribe" who just enters the data so the doctor can actually do doctoring.
On the other hand, my critics, vocal and many, had two major complaints. First, that I'm just a Luddite unwilling to adapt to the new digital world and looking for excuses not to. Second, that while I might have a point about the bureaucratization of medicine, could I not have made it without satisfying my anti-Obama tic and blaming it all on him, and my other itch and blaming it on liberalism?
First, I don't oppose going digital. Properly used, it brings many benefits. The gains, however, are not coming from massive databases attempting to cover and extend to all of medicine, but from far more narrow and tailored adaptations. In radiology, for example, one is dealing with artifacts -- X-rays, CT scans, MRIs -- that can be easily categorized, digitized, filed, transmitted and shared in a way impossible in the age of the shadowed X-ray film held up to backlight.
The problem with the EHR, however, is that the pretense of universality leads to information collection that is largely irrelevant to the patient. And, more fundamentally, that the EHR technology, being in its infancy, is hopelessly inefficient. Hospital physicians will tell you endless tales about the wastefulness of the data collection and how the lack of interoperability defeats the very purpose of data sharing.
As for my complaint about President Obama and his fellow liberals: Again, I don't oppose going electronic. What I oppose is the liberal instinct to (BEG ITAL)impose (END ITAL)doing so, giving substance to that old saw that a liberal is someone who doesn't care what you do, as long as it's mandatory. Why could they not leave the decision of when and how to go electronic to those who use the technology and can best judge its ripeness and usefulness? Instead, the Obama administration decided arbitrarily six years ago that EHR should be universally in use by 2015. Time being up, doctors who did not conform are now penalized through partial loss of Medicare reimbursement.
In time, we will surely develop more tailored, specific and efficient data-collection systems that doctors and hospitals will adopt if only to keep up with the increasing efficiency of their digitized competitors. Why, then, the punitive mandate?
I was in no way arguing that the bureaucratization of medicine began with Obama. It is the inevitable and inexorable result of the industrialization of everything from cloth making to food service, now extended to health care. My point is that, given the consequent loss of autonomy and authority of doctors, why are we compounding their demoralization by forcing an EHR mandate that robs them of both time and the satisfaction of proper patient care?
Yes, in principle, vast record-collection will create mass databases that in theory could be mined to help administrators, and perhaps even to yield medical insights. But it is somewhat ironic that with incessant complaints about NSA collection of telephone metadata -- as of last Sunday, now banned in these United States -- as an assault on privacy and civil liberties, we seem not at all disturbed by the current amassing of mountains of medical data about you and your insides, a literal and far more intrusive invasion of the self.
My argument is simple. If electronic records are such a great boon -- as I believe they eventually will be -- they will be adopted over time as the benefits begin to exceed costs. Let the market work. Let doctors breathe. And while you're at it, drop the Medicare penalty.