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Are Primary Care Physicians Being Assimilated By The Borg?

If you live in a small town or rural area of the United States, you may have noticed that family doctors are becoming an endangered species. Private and public health insurance reimbursement rates are so low that survival as a solo practitioner (without the economies of scale of a large group practice or hospital system) is next to impossible. Some primary care physicians are staying afloat by refusing to accept insurance – this allows them the freedom to practice medicine that is in the patient’s best interest, rather than tied to reimbursement requirements.

I joined such a practice a few years ago. We make house calls, answer our own phones, solve at least a third of our patients’ problems via phone (we don’t have to make our patients come into the office so that we can bill their insurer for the work we do), and have low overhead because we don’t need to hire a coding and billing team to get our invoices paid. Our patients love the convenience of same day office visits, electronic prescription refills, and us coming to their house or place of business as needed.

Using health insurance to pay for primary care is like buying car insurance for your windshield wipers. The bureaucracy involved raises costs to a ridiculously unreasonable level. I wish that more Americans would decide to pay cash for primary care and buy a high deductible health plan to cover catastrophic events. But until they do, economic pressures will force primary care physicians into hospital systems and large group practices. My friend and fellow blogger Dr. Doug Farrago likens this process to being “assimilated by the Borg.”

Doug offered a challenge to his readers – to customize the definition of Star Trek’s Borg species to today’s healthcare players. I gave it my best shot. Do you have a better version?

Who are the Borg:

The Borg are a collection of alien species that have turned into cybernetic organisms functioning as drones of the collective or the hive. A pseudo-race, dwelling in the Star Trek universe, the Borg take other species by force into the collective and connect them to “the hive mind”; the act is called assimilation and entails violence, abductions, and injections of cybernetic implants. The Borg’s ultimate goal is “achieving perfection”.

My attempt to customize the definition:

Hospitalists are a collection of primary care physicians that have turned into cybernetic organisms functioning as drones of the collective or hive. Hive collective administrators (HCAs), in association with partnered alien species drawn from the insurance industry and government, take other primary care physicians by economic force and connect them to “the hive mind”; the act is called assimilation and entails crippling reimbursement cuts, massive increases in documentation requirements, oppressive professional liability insurance rates, punitive bureaucratic legislation, and threat of imprisonment for failure to adhere to laws that HCA- partnered species interpret however they wish. The HCAs’ ultimate goal is “achieving perfect dependency” first for the drones, then for their patients, so that HCAs and their alien partners will become all powerful – dictating how neighboring species live, breathe, and conduct their affairs. Resistance is futile.


To learn more about my insurance-free medical practice, please click here. We can unplug you from the Borg ship!

The Real Fantasy Of Star Trek Medicine: Doctors Without An Administrative Burden

One of my favorite summer activities is watching reruns of Star Trek Next Generation. It’s become somewhat of a summer tradition in my family the last few summers. Having become trekkies themselves, my kids were able to very much enjoy the recent movie, and get the history and lore behind it.

The longevity of the Star Trek enterprise is fascinating. Decades after it’s first launch, it still captures the imagination of inquiring minds and still provides endless hours of entertainment to viewers of all ages.

Even more amazing than the longevity of it’s run is the technology it represents. When the show first debuted, the sci fi components seemed truly out of reach. Today, much of the technology in the new movie and even some of the older shows doesn’t seem that implausible, especially when it comes to health.

Early Trek was a preview of our current Health 2.0 world. When first portrayed, that was not a concept any of us could grasp.  Think about it. In the original series, and continuing through to the latest movie, they used communicators in high tech ways with online computers to search data bases and emails and video calls to talk between doctors at different inter-stellar locations. The doctors even had high tech gizmos to look inside and offer a 3-d look within. All medical records were online and available anywhere. New advances in medicine came from experience, science as well as other cultures and the experience of the treating physician. Patients and doctors could review information online and use that to improve their own care.

What wasn’t so out of reach was the portrayal of the practice of medicine and the limitations of what the human physician could achieve. The bedside manner was always first and foremost the key element to a patient’s survival. The physician treated all patients, regardless of species, and had tolerance for different cultural beliefs in treatment. And, not all patients made it through their ordeal. After all, the doctor was “just a man, not a miracle worker”.

So, Trek’s docs were all health 2.0 with a healthy dose of health 1.0 in that they had these important features:

1. high tech gizmos and computers to diagnose and treat
2. traditional docs to take a history and offer counsel but computerized medical records
3. limits on what could be done
4. online communication with “Googling” ability
5. New advances and lessons from other species to tackle new issues and problems

Sounds a great deal like our health system, minus the insurance headaches, huh?

The practice of medicine is begging to be more health 2.0 but with doctors who very much want and need to be involved and keep their health 1.0 skills. Today we have gizmos that keep becoming more high tech…think robotic surgeons. Today we have doctors still driving clinical care with bedside manner still crucial to the success of an outcome. Today we still have limits of what can and can not be done, with a limit of human life, regardless of our efforts to prolong it. Today we have very robust online communication between doctors, between patients, between doctors and patients, and between everyone and the computer, but with an importance still placed on the face-to-face visit.

There’s one big difference between the docs on Trek and us…insurance. Because of that, what we see on Trek is still just a dream. Those docs can do their jobs so admirably and with great patient satisfaction because they are not burdened with an insurance system gone awry and not forced into cycles of defensive medical practices.

Until health reform sorts out how to allow us to have a patient-focused, physician driven system again, what we see on Trek will remain a dream. What’s sad and discouraging is that is this is one sci fi dream that is actually within reach. Don’t you think it’s time we stopped the insurance companies from preventing us from grabbing on?

*This blog post was originally published at Dr. Gwenn Is In*

Star Trek Movie Review at the Nurses Station

My husband and I did something amazing last weekend. We went out to see the new Star Trek movie before it came out on DVD. You may not find this to be mind-blowing, but we are frugal people. We don’t part with our money easily.

At first I hadn’t planned on seeing the movie. I was afraid that the new movie was going to be a crappy sequel, so I wasn’t going to waste my money on it. Like I said, I’m cheap. Then I heard some of the younger nurses on my unit talking about the movie at work. These kids couldn’t stop talking about the movie. I was amused by their verbiage as they described the movie. One nurse said that the movie was “new, different, and completely groundbreaking.” I just rolled my eyes. I guess they forgot that old nurses like me were watching Star Trek back in the 1960s on our black and white television sets. I just smiled and flashed them the Vulcan peace sign and said, “Live long and prosper.”

My husband and I bit the bullet. We bought our movie tickets, along with a $20 bucket of popcorn, and we walked into the theater just in time to catch the 11 AM matinee. There weren’t too many other people in the place, and the ones who were there were all AARP eligible just like us. I guess my husband and I weren’t the only two old timers who wanted to see what all the fuss was about. I’m not going to give away the plot, but the storyline delves into how the characters first meet up. Unfortunately, Nurse Chapel was nowhere to be seen in this movie. Maybe she’ll show up in their next movie as a student nurse. I’d love to see her in her student nurse pinafore and wearing her nurses cap. They just better not make her into some sort of sex kitten. See my previous rant about Nurse Jackie.

I give the new Star Trek Movie an arthritic thumbs up. Geezers, impress your younger coworkers at the nurses station and go see the movie. They will find it quaint you know about Captain Kirk. You don’t have to tell them that you knew who he was before they were born.

*This blog post was originally published at Nurse Ratched's Place*

HIMSS: A Star Trek Convention Without The Costumes?

My husband Steve and I are at the HIMSS (Healthcare Information and Management Systems Society) conference in Chicago. There are about 30,000 attendees this year and the event is being promoted on billboards around the city and in hotels within a 3 mile radius of McCormick Place. Since President Obama has set aside 20 billion dollars for electronic medical records creation and adoption, members of HIMSS have responded with jubilation (and perhaps even some salivation).

The HIMSS conference might strike outsiders as a kind of Star Trek convention without the costumes. The 881 exhibitors in attendance range from health technology giants like GE, Philips, and IBM to small EMR start ups and software engineering companies to facilitate patient care. There is even a “village” on the convention center floor devoted to demonstrating inter-operability of data systems. Standards organizations like NIST, non-profits like CAQH, and government agencies like the CDC are aggregated together at booths on a huge blue carpet – all working together to share information in formats that their computers can all recognize.

As I looked out on this sea of exhibits, the size and scope of the healthcare industry really struck me. I had been to medical conventions at McCormick place before (the AAFP meeting was there last year, for example), but this time it was filled, floor-to-ceiling, with companies that were not (with few exceptions) hospitals, provider groups, pharmaceutical companies or insurers. Instead, this was an entire additional array of companies, all making a living on healthcare.

The exhibit hall opens today at 2pm, and I’ll be at the conference through April 8th, blogging and Twittering (follow me on Twitter here) my thoughts and discoveries. I’ve got my dark suit, comfortable shoes, and pocket protector in place.

May we all live long and prosper.

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