Dr. Krauthammer has recently written two articles, Why Doctors Quit and Why Doctors Quit, Chapter 2 in the Washington Post:
Please read his articles at the above links.
In this post, the italicized entries are taken directly from Dr. Krauthammer’s articles and the non-italicized sections are my commentary. Dr. Krauthammer describes a misery of 21st century health care in America: the abject interference with the functioning of the doctor patient relationship.—an incessant interference with their work, a deep erosion of their autonomy and authority, a transformation from physician to “provider.”-–Can doctors relieve themselves of this burden? Yes, they can!
If Washington, D.C. politicians cannot create a central, ideally functioning 3rd party payer which eschews this interference; maintains healthy profit for necessary health care businesses; is affordable and paid for by everyone not just by those who pay income tax and/or purchase health insurance; and has as its sole function the collection and distribution of the people’s money to pay everyone’s health care bills, then doctors, summoning great courage, could refuse to accept any payment from any 3rd party payer, i.e., return to a first party payer system. This doesn’t mean refusing to see Medicare, Medicaid, indigent or well-insured patients. It simply means that the patients would be personally financially responsible for the doctor bills they create. Simple plans for payment over time could be developed (office by office), and the patients themselves would have to deal with the 3rd party payer with which they have contracted. The doctors would free themselves from having to engage with public and private 3rd party payer personnel whose perverse and hypocritical goal is to interrupt the practice of medicine by embedding make-work data forms which distract the doctor.—Think just of your own doctor’s visits, of how much less listening, examining, even eye contact goes on, given the need for scrolling, clicking and box checking.—Clicking boxes on an endless electronic form turns the patient into a data machine and cancels out the subtlety of a doctor’s unique feel and judgment.—Does this data entry procedure (scrolling, clicking, box checking) actually create a wall, a partition, between the doctor and patient? Yes, of course it does!
For many reasons, about which I have previously written (pages 22-24 of Equal Health Care For All and pages 22-23 of Socialized Health Care Reform), the doctor patient relationship has been undergoing destruction for years and this EHR mandate which Dr. Krauthammer discusses may be the finishing blow. Why do politicians and 3rd party payers foster this destruction? Because, if you interfere with, i.e., control the doctor patient relationship, then you control a gold mine. Health care bills originate with the work engendered by the equilibrium of trust between a doctor and a patient. And the less money any payer spends, the more that remains for the payers’ administrators to reward themselves and their cohorts for achieving their insidious, deceitful embedded propaganda, i.e., control the cost of health care, which disguises their real underlying agenda, control of the American people. No matter who the payer is if it conflicts your individual doctor patient relationship, it conflicts your health care, a major advance towards the ultimate control, control of your body, your person. Don’t be fooled by the hypocrisy of differentiating between private and public 3rd party payers. Health insurance companies flourish by imposing financial restriction (covered or not covered) on the spontaneous, non-conflicted functioning of doctor patient relationships, and in the Veterans Administration Health Care System, the most pure form of socialized medicine in the world, administrators and bureaucrats flourish while patients get shafted. Ultimately, those who are ceaselessly, persistently trying to control our health care through disruption of the doctor patient relationship are positioning themselves for a high place in the order of political control over the masses. Sound, ongoing, non-conflicted, spontaneously functioning doctor patient relationships are a major human force to counter the advance of this threat to our way of life, the American Way.
I note that in Chapter 2 Dr. Krauthammer says—I was in no way arguing that the bureaucratization of medicine began with Obama. It is the inevitable and inexorable result of the industrialization of everything from cloth making to food service, now extended to health care. My point is that, given the consequent loss of autonomy and authority of doctors, why are we compounding their demoralization by forcing an EHR mandate that robs them of both time and the satisfaction of proper patient care?—Why has bureaucratization resulted in the loss of doctors’ autonomy and authority in their profession? Why have doctors allowed this to occur? Is it because of the money? Has Medicare made doctors rich, and now they don’t want to give that up? They don’t know how to establish a practice without Medicare and other public/private funding money?
Do I have a solution? Yes, I do. Doctors, give up money as your primary goal and the worry about getting paid; give up Medicare and other public funding payments; give up private 3rd party payer payments. For your office and hospital interaction with patients, establish a first party payer system. When you perform to the best of your ability and training, the patients will pay their bills. Reclaim your profession. It’s quite clear that the politicians are not going to do this for you. I predict that they will never develop a central 3rd party payer system for everyone, which reestablishes the primacy of the doctor patient relationship. You will have to reestablish this yourselves. If you wish to have a profession, then be professionals and give up compromising with those who intrude into your private practices by dangling dollar signs ($$$) over your head. Throw these people out with the garbage!
R. Garth Kirkwood MD