Having a long experience in taking care of sick dead and dying people as well as trying to preserve health and wellness, I have seen a lot of changes in the medical field.
At the risk of sounding dated, most of them are not particularly good. Some of them are really nonsensical.
So recently when I read about the national and state sponsored attempts to control prescription pain meds in a tighter fashion I had some historical pondering and perspective.
Right around the time I started my nutraceuticals business there was a movement afoot to document the level of pain of people in Emergency Rooms and hospitals around the country. The current pain scale was being developed complete with smiley and frowny faces to document the level of pain from 1 to 10 with 10 being an abject grimace complete with tears and sweat.
Around the same time arrived something called a Press Ganey. This was a form given to all patients who were able to fill it out. It was the patient’s assessment of how satisfied they were with their care. This data was then fed into a national database so hospitals and doctors could be ranked and evaluated by the patients.
Now if you have ever been really dissatisfied with your care in the health care system you would possibly applaud this. But keep in mind it was also a double edged sword that was often abused. Drug seekers who wanted more drugs and would pop from ER to ER and hospital to hospital looking for more drugs would give bad rankings to the doctors who refused them. It was possible that those rankings could affect the employability of physicians and threaten their livelihood I’m told.
In addition, it created yet another layer of bureaucracy between the doctor and the patient with yet another administrator riding herd over the doctor and monitoring their behavior. Most times these “monitors” were not educated in health care. It is amazing how many people in the health and wellness field know absolutely nothing about human health and wellness and yet somehow feel they should be making decisions that affect it.
When I started in medicine I never had trouble getting a patient’s chart. Somehow the staff knew that the doctor was probably important in the chain of health care. When I started my company the “need” for monitors and administrators had grown to the point where entire nursing stations were remodeled to accommodate “people who were checking people who were checking people and checking off boxes of a to do list that was originated by people who knew nothing about the practice of medicine or the practicality of patient care.
By the end I had to hunt for charts all the time and had more than one occasion where they were “hidden” so the administrator could check the box while I waited to get critical information for the patient. Remember this was before the wide spread use of electronic medical records, computers, apps (which used to mean appetizers) and PDA’s or whatever they now call them. I think it’s just “devices”!
All in the name of quality assurance. The Press Ganey was and is an outgrowth of that mentality.
In the process it created a bunch of new jobs and added incredible expense to health care. Of course all of this was in the name of more efficient and cost effective care.
Almost as comically several statistical studies have noted “the lowest increase in health care costs in several years” citing the current cost increase of 4.1 % in 2016. The average health care premium has increased by around $5000 in the past 5 years. So the “lowest increase in health care costs” seems oxymoronic to me. It’s kinda like the bill board I saw for one of the cellular carriers a while back proudly touting “lowest number of dropped calls”.
Ok so you suck slightly less than the competition and you are proud of it!!! Again I may be dating myself but I never though poor performance would be a selling point. Or how about this one: digital devices will reduce paper usage and save trees. Paper consumption has increased 400% in the past 40 years and currently approximately 4 billion trees are cut down per year now. Of course paper is clean sustainable and paper companies are ecologically conscientious.
Yeah right, and not so long ago tobacco companies were telling us smoking does not cause cancer.
And big food had labeled sugar as the “perfect health food”.
For those of us who took care of people for a living and were in the front lines of that scenario it was an LOL kinda thing.
So 10 or 15 years ago we had to really aggressively treat people’s pain. It was also illegal to call other hospitals to check and see if the person demanding drugs from you already got them from another place very recently.
This past year Phillip Seymour Hoffman and Prince’s deaths changed all that. Honestly I had to wonder how many thousands of drug addicts’ lives were lost by trying to please the administrators. Of course it would be ludicrous to suggest this had anything to do with people dying but I know for a fact some people will modify their decision making processes when “authority” puts pressure on them.
Of course the doctor is always told not to let anything affect their decision making process. Try taking care of 50 people trying to die, telling off an addict and then hearing about it from some administrator. Same thing when someone who is sick and not getting better stays longer in the hospital. Doctors judgement but there may be fall out for sure!
Those interactions were fortunately rare for me but some of my more weather worn colleagues were constantly harassed.
Now there is good in this. Even though thousands probably suffered, remained addicted and sometimes died, the two famous people who died did help to create a wide data base of drug prescriptions. I suppose I should also include Michael Jackson’s untimely demise in this as well although he was not taking something you could get at your local drug store. Still it was probably the beginning of the changes that are now taking place
Maybe more people will get help for their addictions (have you noticed all those addiction center commercials on TV lately?).
I sincerely hope the new laws will balance things out and not swing too far away from trying to relieve human suffering.
I hope you never need to find out!!!
Best, Dr Dave
PS My critics, and there are many, will say that the 3 famous people I mentioned were all quite different in their addictions. The fact is it is highly likely we would have to consider them addicts in need of help no matter what their specific addictions were. You do not have to look to far back but you can go way back if you want and you’ll find many such instances of famous artists, musicians and actors who succumbed to untimely deaths because of the same things. The new laws will not stop this especially among famous people, but it may get more help to “the little guy” who has up until now been mostly ignored.