There seem to be few trusts which have remained sacred. In the field of medicine the most meaningful has been that of the patient-physician relationship based on the Hippocratic principles. You, the reader, may not have noticed but this trust has been the subject of an organized attack in the United States specifically designed to demean physicians. This effort has resulted in a situation where patients as well as their physicians have been the losers because of this.
The vehicle of this demeaning has been the United States governments insinuation into the management of health care and the progressive restriction of the patient’s freedom of choice. With the advent of Medicare (originally inacted in 1965) the United States government began to reimburse hospitals for those qualifying for such patient service. While Medicare has been a “boon” to some, it has also been a “bust” to others.
By 1987 it became evident that Medicare costs had escalated more rapidly than the consumer price index. As a means of controlling costs government agencies initiated a game called “reasonable and necessary.” This game is played by determining which services or parts of services were to be deemed, by them, as reimbursable. The part, or portion, of the service designated as being non-reimbursable was then said to be “unreasonable and unnecessary.” The logic inherent in these determinations has often only been matched by that inherent in that seen at the infamous “Mad Hatter’s Tea Party.”
Because the United States government, its agencies, or “fiscal intermediaries do not actually practice medicine all the patient knows is that their government is constantly telling them that their physician is recommending treatments and therapies which are not “reasonable and necessary” for their welfare. Who was it who said that if “you tell a lie often enough people will begin to believe it”? Another governmental gambit has been to deny reimbursement because the treatment or therapy was deemed to be “experimental.”
On July 12, 2001 United States President George W. Bush met with the democratic members of congress to discuss medicare reform. He pointed out the complexity and inflexibility of the Medicare system as well as its being prone to fraud and abuse. Well, President Bush was exactly correct. In fact, the Medicare rules and regulations are so complex that there is not a physician (or hospital) practicing medicine in the United States today who has not committed Medicare fraud. The issues of Medicare fraud and “compliance” with the laws governing this entity have become, for many physicians, a constant irritant and frustration. They continually deal with ever-increasing burdensome and complex paperwork requiring personal signatures (clearly only for the purpose of legal enforcement). Time with patients is incessantly replaced with red tape.
Yes, there are physicians whose anger has created an abuse backlash and there are those who are simply dishonest. Fortunately, these people do not represent the great majority of physicians. It is also clear that physician anger is escalating. It is difficult to determine whether Medicare fraud is intended or inadvertent simply because the bureaucrats themselves do not clearly understand their own rules and regulations.
The demeaning rhetoric which has clearly eroded the patient-physician trust bond continues on the part of government and the managed care industries. It will only be when the patient is in the driver’s seat in regard to their own health care destinies that the well-established process of competition and good judgment on the part of consumers will allow a better health care arrangement. One has only compare health care with restaurants to recognize the lack of common sense in present paradigms.
The Demeaning of Medical Information
The latest in “buzz” words in justifying and validating medical care has been the introduction of “evidence-based” therapy. The concept of basing medical therapy on valid scientific evidence certainly sounds reasonable. This only requires that the scientific information being used be well-founded. The only problem with this is that scientific information on health care is progressively being replaced with rubbish. Computer professionals call this “garbage in, garbage out.”
How valid is evidence-based medical care when the data being collected is garbage? Well folks, welcome to the wonderful world of medical Disney. You may not have noticed but basic medical data is also undergoing the process of being demeaned and degraded.
The problem starts with diagnosis and treatment codes which are inaccurate to start with. They are also inadequately updated to reflect advanced technology and treatment. One of the most incapacitating conditions known are “regional complex pain disorders” which include causalgia and reflex sympathetic dystrophy. Not only is this not covered by a code but there is no associated staging to allow for appreciation of severity. This is only one example, others abound. In order to obtain treatment for their patients, particularly those in managed health care plans physicians often must “skew” the actual diagnosis in order to qualify their patient for therapy. By the time poor coding and the attempt to obtain therapy are addressed the diagnosis often represents only “garbage.” One can be sure that if the patient were in the “driver’s seat“, and paying for their own care diagnoses would be a great deal more accurate.
How valid then can evidence-base and scientifically “proven” health care be when their data base is unstable and the information is faulty.