Tuesday, April 04, 2006

Administrators are responsible for much of what is wrong with healthcare

The purpose of this blog is to draw attention to ways that physicians can improve the care of their patients. While roaming the blogosphere to find topics for discussions, I am repeatedly drawn into arguments with health care administrators. I suspect that this is because so much of what is wrong with medicine today is in part the fault of healthcare administrators.

For example, Matt Holt on The Healthcare Blog, claims that 30% of what physicians do is “waste motion.” The comments from both doctors and administrators are revealing. You can check out the full thread, but I have excerpted some of my comments.

On the charge by administrators that 30% physician action is “waste motion”:

.., if those experts you quote were willing to take moral and legal responsibility for their pronouncements, I'd be willing to consider them. If they are so certain, let their conscience bear the possibility of causing avoidable deaths.

… As long as I have to take moral and legal responsibility, though, I'd rather trust my own judgment than that of "experts" who are free to walk away from any carnage that they cause.

Furthermore:

The medical system is so unbelievably broken that it is difficult for me to get my mind around it. If you don't think it's completely broken, then you haven't been a patient lately. I have witnessed 20 years of health care consultants and reform and "evidence" based medicine and I have seen medical care get worse and patient dissatisfaction grow, and the worst thing about it is that no one saved any money. They just took money away from the patients and gave it to managers and administrators and consultants who make no one better and save nothing.

Finally:

… over the last 20 years of healthcare "management", the patient experience has deteriorated in every way:

1. The cost of healthcare has not gone down as promised; it has gone up, both in terms of insurance costs and co-pays.

2. The administrative hassle to patients has risen dramatically as insurance companies arbitrarily refuse to cover various items. Spent any time on the phone with an insurance company lately? It's a nightmare.

3. The doctor-patient relationship has been irreparably harmed by the inability to maintain a lifelong relationship with a provider, and the inability of the doctor to offer enough time to the patient.

4. "Evidence" based medicine has failed to affect the quality of care. Bad doctors don't need better algorithms; they need better judgment. All the algorithms in the world will not help if the physician can't make the right diagnosis.

5. The fate of the uninsured is worse in every way imaginable. There is less money for free care, there are more uninsured and the opportunity for many average Americans to obtain health insurance from an employer has declined.

6. Been in a hospital lately? The wheels are coming off of hospital based care. There are not enough nurses to properly care for patients and those who are working are compromised by excessive patient loads. On top of that, they send you home "sicker and quicker".

… administration of healthcare is a complete failure. NONE of the central goals of cost cutting, improved medical care and improved access to care have been achieved.

The fact is that doctors are still taking care of patients and providing value. Administrators are doing neither. If you are still focused on "waste motion", you might consider cutting out healthcare administrators, managers and consultants. I have yet to see any evidence that the patient experience is improved in any meaningful way by their existence.

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