Health Care Reform's Biggest Challenge: Professional Resistance to Change

By Hootsbuddy

My wife is an avid fan of Dr. Mercola because he is an expert on natural remedies and keeps up to speed on the latest ways that drug companies make small fortunes out of tiny pharmaceutical tweaks that often do more harm than good to those who buy them. She asked me just now if I had read Dr. Mercola's comments about Obama's Health Care plan. I answered that I had not because whatever comes out of Congress will make the Obama-Biden Plan that went in unrecognizable.  I didn't tell her that when I peeked at Dr. Mercola's mailout and saw a Ron Paul video I didn't need to go on. It's like scanning radio stations and coming across any of the well-known talk show entertainers whose rhetoric is to reasoning what prestidigitation is to science.

But I digress. This entry is a rant more than anything constructive, but sometimes frustrations get built up inside, you know, and you just have to get them out.

One of the sites I follow is Dr. Richard Reece's medinovation blog. He's a true professional who stands squarely on the conservative but reasonable side of the health care reform debate. One look at the sidebar will tall you more about his ideas and opinions than anything I write here, but I hold his observations and opinions in high regard bdecause he is a clear thinker who (unlike me) resists passion and emotion to advance arguments. For him, like most conservatives, dry reasoning is the only blunt instrument necessary to make a point.

Yesterday's anecdote was a departure from his usual schitck.

This week as a patient I visited three doctors � a cardiologist, a dermatologist, and an ophthalmologist. The cardiologist was in a group of eight, the dermatologist in a group of two, and the ophthalmologist practiced solo but was part of an eye surgery center founded by a number of ophthalmologists.


As part of my visit, I carried a copy of my book Obama, Doctors, and Health Reform as a spark for reform discussion. The book led to lively discussions about reform in general and about specific reform recommendations of others. These recommendations included eliminating fee-for-service, decreasing the number of specialists, and use of electronic records to facilitate care, affords diagnostic support, and decrease waste.


Not surprisingly, was their agreement that ending fee-for-service was an impractical fantasy, that mandatory electronic medical records were overkill and would do little to improve care, and that shortage of doctors in their specialties was imminent. None of these specialists had an electronic medical record system. The cardiologist thought such a system was inevitable but greeted the idea with a notable lack of enthusiasm. The dermatologist and ophthalmologist said installing EMRs in their practices made no sense, and added it would be cheaper to take a penalty rather than install a system.


All shared the opinion that a centralized command and control system could not possibly control all the variables, permutations, and combinations of patient-doctor interactions that went into decision making on the part of patients and doctors. Most thought a centralized government-run system would continue to decrease reimbursement and would lead to rationing.


All were fatalistic about decisions made in Washington, and all doubted any federally-directed system would improve care on the ground. Most thought Medicare fee reductions were likely but were arbitrary and capricious and had little relation with their cost of doing business. All, however, said they would continue to see and accept new Medicare patients, even if Medicare reimbursement did not cover their costs.


This is a small, perhaps even a meaningless and certainly not a statistically significant sample, but it is relevant to the current debate. In my option, it reflects a general resistance and skepticism about federal intervention. Among doctors, there are no miracles among friends, and no expectations of silver bullets being fired from Washington. These physicians have a free market mindset - an intricate voluntary system of economic, social, and cultural interaction representing desires and needs of individual patients and doctors.

I couldn't resist leaving a comment that was every bit as "fatalistic" and any of the ideas or opinions he cited among the professionals.

This is an important observation. You have put your finger on the biggest obstacle of all to reform, embedded resistance to change. REALLY embedded.

Tonight I took a dvd back to the "Red Box" for one of my children. (http://www.redbox.com/)
These places rent dvd movies for a dollar a day. They are state of the art vending machines that only take credit cards. Video rental places are now officially obsolete. The technology is breathtaking. Blockbuster and Hollywood Video rentals will remain for a few more years, along with the growing number of rental stations in grocery stores and other locations. But the handwriting is on the wall. Theirs is a vanishing species.

In my post-post-retirement life I work as a caregiver for (other) seniors. One of my assignments was in a skilled nursing facility where I saw a CNA operate a touch screen console during her shift. She was moving through the screen prompts like a kid with a video game. In a few minutes she documented enough information about five or six residents that would print out to at least a page or two each. It's not likely that much of what she entered will ever be printed or retrieved, but I can assure you that if any disgruntled family member or reward-seeking lawyer wants to bring any complaints to that facility they better have all their ducks in a row because the record I saw being created will be air-tight. (And in the unlikely event that a physician actually wants to know anything, the information will be easy to access, plainly presented and dated.)


These two examples illustrate a sad but real challenge. Technology is here, like it or not, and the future will be built on that technology. There will be fits and starts and unintended consequences along the way. It may be necessary to rear, train and employ an entire new generation of physicians who "get it." But it is going to happen, with or without the approval or acceptance of those standing in the way.


There is a message from the military here for those who cannot see the future: Lead, follow or get out of the way.

Not to put too fine a point on it, but health cared as it stands is no coherent system at all. It presents wildly uneven outcomes, costs and disparity of access. For millions of Americans all the fits, starts and unintended consequences imaginable cannot be any worse than staying the course.

Thanks for listening.  ( /rant )

I'm afraid that in the really long-term America is gonna have to rear a generation of health care professionals, led by physicians and others in leadership, who see their profession as a calling more than a business. Thankfully we have a running start in the ranks of today's professionals but they have been prostituted badly by financial and insurance concerns. As the president reminded them in his AMA speech, they would rather be healers than bean-counters.

My hope is that when the dust settles professionals will feel liberated enough to tell their insurance masters to "shove it" and practice medicine without a need for cherry-picking only the best-insured, most compliant, least complicated cases. A lot of sick people have been waiting (and dying) for a long time.