Tuesday, September 23, 2014

Will Healthcare Reform Destroy The ePatient Movement?

The ePatient movement represents everything that is positive in medicine today.  This grass roots force has introduced shared decision making and empowered both physician and patient.  The quality of healthcare dialogue has risen meteorically both in the exam room and out.  Today's healthcare "consumer" is more engaged, more intelligent, and more agile at wending their way through the confusing maze of sickness and health.

It's awfully sad that it has to come to such an abrupt end.

While you may accuse me of hyperbole, there is plenty of reason to believe that the gains made by this important and patient centric revolution will fall victim to the machinations of healthcare reform.  How could legislation made to benefit the populace have such untoward effects?  Its all about intentions.

The architects of the Accountable Care Act and the mountain of legislation that will follow were faced with the difficult task of allocating scarce resources to a growing and unsustainable national debt.  Instead of an open and honest conversation of rationing, the beltway answer was to hire a group of medical ethicists to convince us that population health is more important than the doctor-patient dyad that has been the basis of medical care for centuries.  Thus physicians become the steward of the population, allocating these resources as they see fit to benefit the community.

This version of healthcare is the complete antithesis of the ePatient movement.   Medical decisions are not inclusive, not patient centric, and not up for debate.  This is the ultimate form of paternalism.  The doctor feels that your expensive chemotherapy does not sufficiently benefit society.  There is no discussion.   Such statements would be almost laughable if not for the recent article by Ezekiel Emanuel in The Atlantic.  According to this prominent author and proponent of Obamacare, you (and society) will be better off if nature takes it's course swiftly and promptly if you are over seventy five years old.  And why not?  Zeke tells you it is so.

The ePatient movement extolls taking power away from central authorities (or paternal doctors) and placing it squarely in the hands of the patient.  Ezekiel Emanuel can't divine your values, life goals, or interests.  How can he decide what medical treatments are right for you?

The situation worsens if we consider the new structure of our healthcare system.  President Obama's self stated intention was to collect large groups of doctors into big organizations.  These organizations, he reasoned, would facilitate a team based approach sown together by technology and the abolition of fee for service.  He reasoned that doctors on salary would be much better penny pinchers and stewards of our national piggy bank.

As we have seen across the country, the cataclysmic mergers of hospital systems has created a majority of employed physicians, strapped to computers, and mired in the bog of administrative minutia.  Patients are becoming last in a long line of mistresses.  Physicians answer first to their hospital system, next to their electronic medical record, and then comes the government.  At some point, if your physician has enough time to leave his "team huddle", he may be able to see you a few minutes between most precious key strokes.  You are an afterthought.  There is no empowerment here.

In conclusion, I think the way forward for the ePatient movement is clear.  You have fought like bats out of hell against the paternalistic, backwards ways of the past.  It's time for you to turn your attentions to a more sinister villain.

Your government.


e-Patient Dave said...

Hi Jordan - thanks for raising this question. I'd welcome a phone call to discuss, because I think you've completely misunderstood (or grossly underestimated) what the e-patient movement is about.

Patients waking up about their ability to think for themselves, and clinicians welcoming it, is a separate issue from whether current regulations make it easy. I don't have an opinion on the obstacles you cite (I don't know enough), but this unstoppable change will no more be destroyed by regulations than the women's movement or the civil rights movement were.

I'm glad you as a practitioner support the movement, and I'm not happy about regulatory issues that get in the way of clinicians and patients just plain DOING HEALTHCARE. But how I approach clinical relationships is internal to me - there's not a chance I'd behave differently under different laws.

Note: in the start of any movement some of the oppressed class are relatively meek, or not yet aware that they're allowed to speak up. Over time, that changes.

Again, if you want to have a call to discuss, dig me up - contact info is on my site....

Anonymous said...

I think he has quite a good grasp on what is going on. Medical boards don't answer to us. The govt. doesn't answer to us. Doctors answer to every one else.

Anonymous said...

you are right Jordan. The Emmanuel article, which we all know represents the present administration attitude, is absurd and offensive. His tune will change when he realizes how alive and vital he feels (if he's lucky) at 75, and he'll want anything done to keep it that way.

Christine Robinson said...

I'm with you and briarcroft! I'm 75, alive and feel vital. I'll want everything done to keep it that way...as I age. Thank you Jordan! I was a nurse practitioner in psychiatry until retirement last year. Now, I'm a full time writer and want to stay healthy with good health care for years to come. Mr. Ezekiel Emanuel must be 30-50 something with no cherished "old people" (75 or older) in his life!

e-Patient Dave said...

> Emanuel: "You and I will be better off...."

What am I missing? The column is about what HE wants, yes? (No?)