Pepi Granat, MD, a Family Practitioner and Praxis client, comments on the usefulness of preventive medicine and puts things in perspective. Food for thought!

The Elephant in the Room

After all the discussion of EHRs lowering costs because of the ability to micro-manage the physician with issues of Preventive Medicine, there is this interesting position by Pepi Granat MD, a Family Physician in Florida and a Praxis client, to think about.

Again we avoid -- or don't know about -- the elephant in the room.

The FACT (again, see Kristen Leutwyler's scholarly article in the April, 1995 Scientific American) that more preventive medicine WILL NOT lower costs, it will raise costs. There are many reasons to do preventive medicine (& it is the thrust of our specialty), but the "outcomes" they're looking for will NOT lower costs, but will raise them.

Yes, colonoscopies will detect cancer and may save lives. Then those people live on & need more care & eventually everyone dies of something. And the price of giving much more care to many more people (who now don't get or seek care) far outweighs the few bad diseases gone sour because of lack of early detection. This is all nicely outlined in her article. GO READ IT. No one wants to admit this. But it is a setup for failure for the real desired outcome of the politicians, is less cost, not better health. So yes, they will say, "Look what we did for these doctors, & look what didn't happen."

Real better health for more people will cost MORE, not less, w/ or w/o HIT.

And there's one other elephant in the room: real medical care (especially what we famdocs do) is more about process than outcome. Yes, outcome, when possible; who doesn't want & strive for that?. But much more often, of the 3 tenets of medicine: to heal sometimes, to relieve often, to comfort always, only the first relates to outcomes, the other to the process.

One can see that what we do often & always, relieving & comforting, is PROCESS. And I wonder how we can measure that w/ HIT or any other way, except our patients, voting w/ their feet.

These 2 elephants put the kibosh on the high-falutin' claims for "heath care reform" and improving efficiency.
PG

Note: Praxis will handle reporting better than any other EHR in market (see our paper ...) but the real question remains...what are the third parties doing?