(If I fellow could keep his head and not get caught up in the hysteria surrounding health care, if he could just keep his mouth shut and his eyes open he might see the real problems in the system without being blinded and deafened by the usual propaganda from the usual suspects using Health Care as a fulcrum to leverage their way into political power. Unfortunately, the solutions being proposed to solve the problem of increasingly expensive health care and the so-called “lack of access” are going to compound the very problems they are supposed to fix.-PB)
The Paper Mill
In a proprietary process understood by few but a marvel of unintentional design, living patients are turned into paper. I read the chief complaint and open the chart, already primed with fifty pages of seed paper, and go to work sifting through the catalogue of promises, obligations, and warnings, every action of mine laying the groundwork for the creation of even more paper. From the Diversity affirmations to the pre-printed discharge instructions that nobody ever reads, the chart is a masterpiece of bureaucracy and wasted effort. The HIPAA section alone spans nine pages that no patient has ever read and could be Proust for all they care. And yet to not initial and sign where appropriate will cause the heavens to weep and the hospital attorneys to gnash their teeth in fury.
I would not be exaggerating in the slightest if I said that for every hour of direct patient care, things like obtaining a history, doing a physical exam, and performing procedures, I spend three hours manufacturing paper, some of which is necessary documentation but most of which will never be used for anything and will end up mouldering in the crypt known as medical records until the sun should fail and the sea shall give up her dead. That is, unless it is dredged from that antediluvian mire as evidence for a spurious lawsuit against a doctor who was only guilty of doing the best he could with a patient who would have made William Osler himself cringe and the Great Galen’s blood run cold.
In fact, there is no part of the hospital or the clinic not primarily dedicated to the paper trade. Ask any nurse and she will tell you that most of her time is spent sorting through the increasingly arcane compliance and safety documentation which is the delight of bureaucrats and thier familiars but contributes nothing to the medical care or safety of patients. Twenty minutes here to fill out a medication reconcilliation sheet, fifteen minutes there to document that she has had her hand washing refresher training and pretty soon we’re talking hours that could be used for direct care of the increasing numbers of patients they tell me are clogging our hospitals.
Judging by the incredible cost of in lost productivity as well as the very real opportunity cost of treating paper instead of additional patients, the most expensive phrase in the history of the world has to be “If you didn’t document, it wasn’t done.”
What does this mean, anyways? That good medical care wasn’t delivered if you didn’t spend an hour writing pointless notes? That because you didn’t meticulously copy lab values from the computer onto another piece of paper that you didn’t look at them? Or does it mean that if you didn’t document that the surgical field was “prepped and draped in a sterile manner” that you ate a taco over the incision?”
What it really means is that the legal environment has become so stifling that nobody trusts anybody and huge amounts of money are wasted covering our asses. Forget the money awarded to plaintiffs and their attorneys in malpractice suits. Forget the cost of defending against lawsuits where the defendant is held harmless. As our lawyer friends are eager to point out in order to distract the public from their depredations, these direct costs are chump change. Even malpractice insurance, although it can be as high as a quarter of a million dollars for an obstetrician in Florida (and is a cost, like most business expenses, that is passed on to the consumer, whether private of government) does not come close to the cost of the bureaucracy which is necessary to keep the inquisitors at bay.
It is a difficult problem to correct. Like vultures to carrion, lawyers will follow the cloying smell of money rising from the hospital. Lawyers run government and unlike physicians who have real jobs, a lawyer can make a career blocking meaningful tort reform and get paid for it, not to mention winning the adulation of people who on one hand view the right to sue as inviolable but on the other would have no problem appropriating private property (the doctor’s time and labor) and as much of other people’s money they can possibly steal to pander to their own narrow interests. As for Alexander Hamilton’s great beast, the people, they are unfathomable. The number of people who have hit the malpractice jackpot, winning big awards after a bad neurosurgical outcome for their wino uncle who they ignored until he was found unconcious under a bridge, must be very small and yet appeals to the greater good, cheaper more efficient medical care in exchange for a cap on compensatory damages, fall on deaf ears.
Apparently, nationalizing health care under the false flag of Single Payer and redistributing several trillion dollars a year through the federal sausage mill is easier than passing a few legal reforms.
Somewhere in the rat’s nest of paper originally created by your hospital’s risk managers but now continuously growing as if alive is your patient, protected from your depredations by paper; the sword, the shield, and the strong arm of the bureacracy.
Next: Charles Ponzi Would be Ashamed