NOSH ChartingSystem

A new open source health charting system for doctors.

Love Will Tear Us Apart, Health Care Edition

1 Comment

In recent weeks, there have been some interesting articles that seek to explain the problems of the US health care system.  For example, in David Borstein’s opinion piece in the NY Times, “Who Will Heal the Doctors?”, Mr. Borstein talks eloquently about physician burnout and the aims of the Healer’s Art, a medical school course meant to help doctors and students rediscover and reconnect to the meaning of their work.  In his piece, the concept of the “McDonaldization” of medicine as the source of physician burnout first appeared.  And conceptually, it seems to be another analogy to “CorpMed”, or Corporatized Medicine.  Dr. Wes opines that the source of burn out is not just from the “McDonaldization” of medicine, but rather from “growing hostile dependency patients have towards their doctors.”  He cites several comments from Mr. Borstein’s article that appears to support his claim, as well as some disturbing  trends that he has observed.  And in one sentence, Dr. Wes encapsulates everything that is wrong with our health care system today.

So when we spotlight doctor burnout, or, say, the lack of patient safety in hospitals without acknowledging the realities health care workers face like looming staffing shortages and pay cuts, we risk fanning the flames of narcissistic rage against the very caregivers whom we depend on the most - the very caregivers who are striving to do more with less, check boxes while still looking in the patient’s eyes, meet productivity ratios, all while working in a highly litigious environment.

While I understand the basis of this concern, I think we should take a step back and realize that this uneasy feeling is the end result when patients and doctors are intentionally wedged and divided by forces that place us in opposition to each other.  I’ve spoken about this here where I talk about some of these forces, and how I was a victim of the system here.  When I talk about these forces, I am talking about a system of health care that is built in such a way where doctors and patients are not allowed to see eye to eye.  This is a system, intentionally or otherwise, which thrives on and encourages the fragmentation of health care.  This is a system that is built from the foundation and belief that health care dollars are infinite when in fact all of our resources are structurally finite.  The system is accepted by doctors and patients as an acceptable normal.  But yet, I think we all must feel in some way that something isn’t quite right here.   We are all culpable in this situation, because it is our status quo, it feels comfortable, and perhaps it is the system that was promoted many years ago by our previous generations.  But doing nothing about it may end up with our health care becoming a victim of itself, to the detriment of everyone involved.  Ian Curtis of Joy Division eerily summarized how this whole situation could be playing out between doctors and patients…

When routine bites hard,
And ambitions are low.
And resentment rides high,
But emotions won’t grow.
And we’re changing our ways,
Taking different roads.

Love, love will tear us apart again.

Contrary to the status quo, I see a vision of health care that could be dramatically different, where doctors can be of direct service to their patients again.  Some doctors have chosen to move towards a direct pay model as a stick in the eye to the current health care system where primary care physicians are undervalued and underutilized.  I applaud their efforts and I think there are patients that resonate with these different and highly engaged models of healthcare.  Other communities have embraced a type of  healthcare that focuses on lifestyle changes, focusing on mindfulness, and a holistic view of health care that aims to reconnect the healers even though these types of treatments may not financially rewarded well.  Nevertheless, it is an important step, and it is further evidence that we are, as a population, are looking for a better model of the doctor and patient relationship.  I believe that health information technology is also not immune to these types of disruptions, however small they may be at this time.   This is why I feel that using  technology that aims to bridge the digital divide between health care providers and between doctors and patients is the next step towards the goal of improving the doctor and patient relationship, if done thoughtfully.  To me, an open-source health care software movement, where proprietary, locked-in technology and high cost goes out the window, is the best way to achieve this goal.

To me, the first step towards doctor and patient cooperation starts with regaining ownership of health care data.  Right now, the data is increasing in the hands of agents that encourage our current health care system, where data and analytics aim to improve the bottom line, and not necessarily for the general well-being and health of our communities.  This is where the “McDonaldization” of health care will have met its ultimate Orwellian goal, where the health care providers will no longer enjoy the art of practicing medicine, and patients will be defined as widgets and data points rather than real people with diversity,  experience, cultures, and backgrounds.  It’s not too late, but if this is not the vision you hope for in our health care system, you are not alone.  Let’s start engaging, talking, and unleash our desire to change our health care for the better.

One action that you can take today is to support my open source project.  This is a community-based effort.  We need to start somewhere.  There are only 5 days left to go on my Indiegogo campaign!  Let’s do it!

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Author: shihjay

I am a family physician and previous medical director for a child abuse assessment center. I am now promoting my new electronic health record system (NOSH ChartingSystem) that I have developed and used for myself in my private practice since 2010 and now I want to share it to the rest of the doctoring world.

One thought on “Love Will Tear Us Apart, Health Care Edition

  1. Dr. Chen, I found your Indiegogo campaign by chance, and I then followed the link to your blog, and I’m writing because I so resonate with everything you have said about the healthcare system. As an occupational therapist in a homecare agency that is part of a large hospital system, I can tell that our electronic medical record and the associated technology is eroding the soul of everything we do! This is not an exaggeration. The only conversation we ever have is about how we can improve our “productivity” by using the computer system AND how often that system fails us. It’s big, slow, and clunky in an age when most of us are used to touching a screen and connecting instantly with a loved one everywhere else in cyberland. I applaud your project and hope that you keep putting it out there!

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