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Monday, September 29, 2014

Cookbook medicine by demand or force?

I'm a big football fan.  One of the reasons I watch football, and I think other sports fans would agree, is because it allows me to escape life for a while.  I like sports because it's not real life, and its not politics.

But many of the top sports networks, particularly ESPN and CBS Sports, have forced us to endure politics while watching the pregame shows and even the games themselves.  I mean, it's to the point that sometimes I just turn the games on and watch them without sound.

Last Thursday, while I was watching the Redskins and the Giants with sound, I had to listen to James Brown say this:
Here in Washington last week US Senator Maria Cantwell of the state of Washington led a small group of senators that introduced legislation aimed at revoking the NFL's tax-exempt status if the league fails to force Washington owners Daniel Snyder to stop using the term "Redskins." Several prominent leaders in the Native American community, including Dennis Welsh of the National Congress of American Indians, the oldest and largest organization of its kind, have repeatedly stated that the Washington team nickname is derogatory.
I don't care if you agree that the Washington team nickname is derogatory or not, as that's not the point of this blog post.  However, what's key here is that this is the kind of stuff I don't want to hear when I'm watching a fun game for entertainment. It's the kind of stuff I expect when I tune into Fox News, or CNN or MSNBC and during episodes of CBS News Tonight, but not during sporting events.

Ironically, this was the same game in which former Giants quarterback Phil Simms attempted not to use the nickname "Redskins," instead opting, awkwardly at times, to refer to them as "the team" or "the Washington team."

Here's what he said at one point in the game:
The Washington team, they have a lot of weapons... They play a lot of man coverage, the wash -- the Washington team does. ... Let's see how the Washington team plays.
I don't know, it was kind of awkward, at least that's what I thought.

I'm digressing here, because what I really wanted to talk about was the comments by Brown, and I wanted to relate them to medicine. It's this that allows me, I think, to write about this here on this non politically correct health blog.  What Brown said is exactly what is broken with our healthcare system.

You see, there are some things people do not want. In sports, studies show most people are in favor of teams allowing Redskins to be called Redskins. Studies also show that 90 percent of Native Americans do not consider the term offensive either.  Most people do not see the name as derogatory and therefore don't care if the team changes its name.

Still, a small minority thinks native Americans should be offended, and so this minority is trying to force the team into changing its name.

But none of that is as important to us here in the healthcare profession except for the how they propose to do it.  Because we have a Constitution, they cannot force the Redskins to change their name.  So what they do is they say that if the NFL does not make them change their name, the NFL will lose its tax exempt status.

In other words, if this law passes Congress, the NFL will have no choice but to make the Redskins change their name.

The same thing has happened to healthcare.  Doctors for years have resisted cook book medicine that results from order sets.  However, in order to save money (or, as they referred to it, in order to save lives) CMS has passed regulations aimed to cut reimbursement to hospitals that don't comply.  In that sense, hospitals are essentially forced to comply.

It's by this reason we do too many EKGs, and too many breathing treatments, and too many smoking cessations.  It's why nurses and nurses aides do too many neuro checks, and IV starts.  It's why we all have to do too much charting, and why we have to chart when we should be taking care of our patients.

Of course, to make sure we're doing all this stuff, hospitals have to hire more workers to make sure we are doing it and doing it right.  In many cases, this comes at the expense of hiring one more therapist, or one more nurse, or giving raises. In many cases, while regulations are always created with good intentions, complying with them often comes at the expense of good healthcare.

This is what it's come to in healthcare.  Personally, I couldn't care what the team in Washington is called.  But the name should be changed because the owner thinks it's the right thing to do, not by a faux mandate by Congress.

Healthcare is no different.  Doctors and hospitals should not treat all patients with like diseases alike, but should treat all patients individually.  If a hospital or doctor chooses cookbook medicine, that's fine.  But they should not be forced by a faux mandate from Congress.

General George S. Patton had a nice quote that we can use here to conclude this post: "Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity."

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