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    Wednesday, March 22, 2006

    Help Wanted III: Every now and then I get a glimpse of the future, when there won't be enough doctors to take care of all the sick and needy. It often happens during flu season - even mild flu seasons like this one - when the hospital is full to capacity and patients are left waiting in the emergency room for a bed to open. It's those times when you can see the fractures in the system that are going to open wide in another ten or fifteen years when the boomers are in their seventies. Everyone seems to be stretched thin during such times. The specialists make fewer and more cursery rounds on the patients I've consulted them about. Families complain that "no one's talking to them," and "So what if that intensive care doctor had three stroke patients to take care of, if he has to take care of three sick patients in addition to my [insert family member] then they need to hire more intensive care doctors." (That's OK. They're just demanding their more-than-seven-minutes.) And, of course, I , too, find myself stretched thin when the census is high and the demands great. A thirty minute discussion with one family, means the next family is going to get 15 minutes or less. There are only so many minutes in the day. Nothing's ever going to change that. So, you try to arrange it so the most time goes to those who need it most. That means the sickest get the most attention. Sometimes it might not be the sickest, but the sickest who have the best chance of surviving.

    But, of course, patients and their families don't see it that way. Every sick person and their family member is going through a trying time, and their needs are paramount. It doesn't matter that the patient in the next room is having a stroke or a heart attack. Let them get another doctor or nurse.

    So what's going to happen when the baby boomer demographic reaches their age of sickness even as the number of doctors and nurses continues to decline? Expect the quality of care to decline. Maybe we'll stop putting people on ventilators after a certain age, or stop doing dialysis after a certain age. Although, it's hard to imagine the boomers taking that kind of rationing lying down. But sometimes, after days like today, it's all too easy to imagine that in the future hospital intensive care units will be overflowing but there will be no one to take care of them. And when that happens, about all you can do is stop doing intensive care - except for the young and the salvagable.
     

    posted by Sydney on 3/22/2006 09:14:00 PM 5 comments

    5 Comments:

    I am an expert in computer systems for businesses and I am appalled at the state of automation in the medical industry.

    The medical industry is at least 25 years behind the rest of the economy. Computers have greatly reduced the need for middle managers, accountants, lawyers, architects, mathematicians and engineers. The same should be happening to the medical profession and it is not.

    My experience with doctors is that they refuse to give up their pencil and paper or to change their work habits so no automation is possible. The shortage of doctors will force the profession to join the 21st century so I am not worried about the lack of care in the future.

    By Blogger Jake, at 10:09 AM  

    Jake: You're right. We are a pretty technophobic bunch. I don't know why that is. I think us younger docs, though, are embracing important technology, like EMR (electronic medical records). Not fast enough, though.

    By Blogger Albert Fuchs, M.D., at 2:37 PM  

    Cost is the issue, mainly, I think. That and the existing systems generally don't save money or even that much time. Front end, it means purchasing a reliable system and hardware with training and support contracts. Even for a small office, that easily runs into six figures and imposes several months of inefficiencies as staff becomes accustomed to the programs. Data entry is generally not timesaving for the doctor, there is just more interface with the computer. There is some savings in costs of time in filing, looking for charts, etc., and whatever is saved by keeping dead files in electronic files versus boxes and storage shelves.
    For small offices the benefits to those who have to pay for the systems are not as great as is for big institutuins like university hospitals with many distant inputting departments and many possible accession points.

    The fact that practices are being told to modernize at the same time as having reimbursement cuts does nothing to help matters either.

    By Anonymous Anonymous, at 9:14 AM  

    Jake,

    I agree that the amount and execution of IT in medicine is poor however I disagree that any amount of technology will speed things up. The time-consuming part of medicine is not writing the note and orders (a recent study on physician order entry actually showed a 317% INCREASE in physician time needed to write orders by the way). What takes time is seeing, examining, and talking to the patient. Whether or not automation/IT will improve quality care is another story.

    By Blogger Bladedoc, at 4:48 PM  

    It's Saturday afternnon and I'm half-listening to the opera at the Met on NPR while browsing thru my favorite blogs.

    The posts on this topic make me wonder - if the Met were computerized, would it be more efficient?

    Would it be possible to produce a performance of Tosca or La Boheme in half the time?

    Would I enjoy that more?

    John Fembup

    By Anonymous Anonymous, at 2:09 PM  

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