I believe that those controlling the purse strings are steering modern medicine towards the practice of seeing patients more as the sum of their medical problems than as individual people. Patients have become streams of data as opposed to real human lives.
Consider the dynamics of a family: a wife may worry about her husband while their child adores a father she instinctively knows to be irreplaceable. Modern medicine, however, may only see a diabetic with hypertension and a cholesterol-level running too high. The computers programmed for those advocating the power of data to revolutionize medicine would boil this man down to his “meaningful” essence — numbers, for the above imaginary man: 250.00, 401.0, and 272.0.
Once our patients have been decocted into their numerical essence, computers can more efficiently track a doctor’s treatments and outcomes (as in England, today, where these numbers create a formula that determines part of the government-employee-physicians’ salaries). In 2012, Uncle Sam will begin rewarding doctors with more Medicare money for “meaningful use” of patient’s health information. These additional dollars will be available if physicians provide patient data and other numerical codes in a pre-defined data-friendly format as their offices submit claims to Medicare. Less money will be paid to those practices failing to be “meaningful” in their claims submissions.
These codes are being used by insurance companies, government agencies, and even employers to track our health and the ubiquitous use by all belies a belief that the sum of one’s codes can equal a living person. This could not be further from the truth. Codes do not allow any room to treat people as individuals. A coding mistake made by a doctor’s office could have far-reaching consequences.
I recently cured a man of stage III chronic kidney disease simply by using the calculator I had carried in college. He had been denied life insurance and expressed a frustration with modern medicine and his previous doctors for treating him “like I was on an assembly line.” He said that he came to me because he felt fine, couldn’t understand how he had a kidney disease, and our medical practice operated differently. He asked me to review his records, question everything, and stated that he wanted to pay me for my time.
When his records came in I noted that the diagnosis of his kidney disease had been erroneously based on a laboratory report that “calculated” his estimated creatinine-clearance assuming an average weight. This number had been directly transferred to his chart, without question. I looked at his weight (he was very tall, muscular, and is my age which is also young) and plugged this data into the formula for creatinine clearance. My calculator showed a normal value for creatine clearance (i.e. no kidney disease.) He warily received my good news and asked if there was a way to get proof. Three days later we had the results of a 24-hour urine collection and this also showed a normal creatinine-clearance and no kidney disease.
This patient’s instinct was spot-on. He was on an assembly line greased by a dependence on data that was slowed down each time someone was considered as an individual, much like the Visa Check-card commercials when someone produces cash and all joyful motion stops. I take offense at how the term “meaningful” is being used in medicine today. In my practice, “meaningful” refers to the individual relationships I build with my patients to ensure that they receive the best medical care possible — not how I convert someone’s life into a string of data.
Until next week, I remain yours in primary care,
Steve Simmons, M.D.