Category: System

After 30 years working in longterm care homes, an exasperated nurse fumed about nursing directors who’ve never nursed a day in their lives. She endured criticism for not following guidelines that were written by experts who had never provided care, inexperienced experts.

The evil that is in the world almost always comes of ignorance, and good intentions may do as much harm as malevolence if they lack understanding.  Albert Camus

Years ago, costly education meant fewer people had credentials.  Workers earned their merit through experience and skill, not credentialism.  Clinical training still requires years outside the classroom, at the bedside.

Mastery requires experience.  We listen to horticulturalists with dirt under their nails. Great leaders know the job and get their hands dirty (and Forbes).

Inexperienced experts everywhere

• Education curriculum created by non-educators
• Best practices for child raising by people without children (not even adopted or foster care)
• Medical process dictated by bureaucrats
• Quality care defined by non-providers
• Efficiency described by experts without experience in industry
• Fiscal policy written by people who only know crown corporations

Do you need to have a PhD in every -ology to be the Dean?  Of course not.  But, inexperienced experts should only lead if outcomes are obvious and failure is a real option.

Inexperienced experts undermine trust in all leadership.

Once upon a time, you went to your doctor when you felt unwell, and your doctor tried to help you.

“Now, we are seen as negligent if we are not hounding our designated list of patients to meet current practice guidelines, which might be different tomorrow,” my uncle said.

Big data collects everything.  Every tiny bit of data that could be recorded gets stored for retrieval and analysis later.  Every blood test, x-ray report, clinic note, and screening exam goes into an electronic medical record (EMR).  From there, it loads into an electronic health record (EHR) linking other providers.  It require a ton of effort to keep personal data secret.

A family physician from a well-known clinic in the US, spoke with my uncle:

“Turns out that one use of their EMR is to publish how all the docs are doing meeting screening and chronic disease management guidelines, as well as patient satisfaction. Then there is negative feedback from other providers toward those who are not keeping up to target. The pressure comes from their payer who is very much into running a profitable business [although non-profit officially]…”

When is Big Data Big Brother?

This issue has been discussed recently about security in VW cars (Forbes), and planning and safety in Boston (eWeek).

Mathew Ingram writes about ‘The Increasingly Blurry Line Between Big Data and Big Brother” (photocredit).  He suggests we need to control the use of the data to prevent big data becoming big brother.

Gerd Leonard spoke with CNN about big data.  CNN writes that

“Soon, the question will no longer be whether we have the technological skills and horsepower to do something, but why, when and where we should do it (never mind the thorny issue of ‘who’). “

Big Data will change medicine, redefine what it means to practice.  George Orwell might tell us to keep patient needs first, and challenge big data’s use for anything else.

“Possibly one of the biggest deterrents against retirement is that we become consumers only in the system. That’s got to be even scarier than being a provider.”

 

Twenty years ago, we bragged that Canada had the best healthcare in the world.  Our 1970s reputation of free, low cost care for all sustained our pride into the 1990s.

Not anymore.

We fall behind most other systems in Europe.

Now we brag that we cost less than American healthcare.  No one who knows the facts argues that Canadian healthcare is the best in the world anymore.

Why Canadian Medicare Fails

No patient accountability for cost

No provider accountability for cost

No government accountability (just raise tax)

Providers fear litigation encouraging defensive practice (cover your butt)

80 % Unionized vs. 18% in private sector (++pay, pensions, benefits)

Insufficient infrastructure

Painfully ancient IT, or no IT at all

Poor integration

MDs cannot fully leverage knowledge by billing for delegated care

MDs left out of leadership

Over regulated

Managed by bureaucrats

MD and hospital incentives misaligned

Price fixing has not worked in any industry.  Ever.

Our insurance program was built for rare medical catastrophes when the average age in Canada was 25.  It now functions as a warranty program for common, chronic conditions when the median age is 40.  In 1960, 7.6% of the population was over 65. By 2013, 15.3% were over 65.

Failing systems ration services.  The old lose out first (Daily Mail 2014,  2013, and  Guardian )

Does our 40-year-old Medicare system deliver compassionate, outstanding service and quality to everyone?  Or, does it depend on whom you know, whether you are a professional athlete, or whether the service is billed outside of Medicare (E.g., WSIB, RCMP, Military, tourists, etc.)?

Fundamentalists tell us that Medicare fails because we do not have enough of it.

No, Medicare fails because ideologues refuse to allow us to improve it.