This is exactly what I want to do after I complete medical school/residency/fellowship. I've been coaching for awhile and plan on continuing to do so, need to further refine my "coaching" eye. But this is something I will do. I'll look you up in about.....6 years or so. Lol.
This will be a multi-part post that I undertake with some trepidation. The first part is easy though. My friend from jujitsu and I had a chance to talk over your article Sully. As I thought it would, it had a powerful effect on him. The same thing that resonated so significantly for me struck him as well. The unchallenged cell's "decision to die." Maybe it's the age thing on our parts I don't know, but it hit him right between the eyes. He started asking me about the relative effectiveness of pushups to bench presses or some other loaded movement. I told him increasing weight and load was the key and repetitions less so. So maybe he'll get some more iron in his blood. We'll see.
This is the part I have trouble with. Not government getting out part or staying out, but the true understanding of what happens behind the curtain of the transactions between the doctor or hospital or the billing department and the entity that pays for the treatment or medication. I don't profess to understand that part of it. Dearly Beloved gets it better than me and those of you who are not married will inevitably discover that when you do, your significant other will have an excellent grasp of the ins and outs of this from her own experience and check ups and will get your own part of this equation in good marching order with little or no effort on your part. When kids come into the bargain, all this goes double.
Originally Posted by Sullydog
I don't want government involved. When government becomes even more intrusive then it was even two years ago, they will inevitably begin to look for ways to cut costs. The private sector too? No doubt they will too, but they do not have the same extensive power. One aspect of ObamaCare that bothers me the most is the premise that digitizing the records of patients will achieve huge cost savings and efficiencies. I am no IT expert but I call BS. The downside of the huge government database of health care records in the Tron world is immense. Compromise, hacking, and data mining is inevitable. I know enough about the frailities of human nature and greed with respect to selling our nation's secrets to have few doubts about the sanctity of this data. Here in LA LA land hospital and medical info is sold to the National Enquirer or TMZ routinely. Any talented or rich individual or entity who wants some or a lot of information from this repository will get it easily.
Hell, every week the Feds and others lose laptops with all manner of information on them. In my own company HR lost one, and the credit union each lost one within months of each other. Even the FBI carelessly disposed of some PC's containing witness protection information a few years ago. Is the current system with my HMO or PPO the answer? It's working for me and my family so far, thanks of some creative billing practices and careful consultation with Dearly Beloved. But the best? I'm certain not. Just keep the government out of my business. I'm in deep enough already of my own volition because of what I do.
I said in my next post that I'm not championing the idea just wanted to show an example of what to me is the other end of the spectrum of govt run health care. However, I would have absolutely no problem with telling people with scraped knees or the sniffles who can't pay to go home, use a band aid or cough medicine or whatever over the counter measure would fix what ails them. I'm no doctor, nurse, emt, but I have taken a combat life savers course (thankfully never had to use it other than hung over monday's with a self administered IV). A lot of what I have seen in the ER would be given a bandage, some ibuprofen, water and told to get the sand out of their female nether regions.
Originally Posted by spar
Last edited by Matt275; 09-16-2011 at 09:45 PM.
Reason: changed I'm championing to I'm not championing
Too late. Government has been involved, continues to be involved, and will be involved, barring some sort of geopolitical-socioeconomic-environmental Singularity that would make all of this quite irrelevant. And electronic medical records are here to stay, too. Regardless of how you or I feel about these things (and frankly, my good friend, our views are probably pretty divergent on this topic), the toothpaste is out of the tube.
We all want our nation to be strong and healthy and prosperous and boast the best care in the world and cutting edge research and teaching and total privacy and cost-effectiveness and complete freedom and .....well. I just don't think we can have it all. We have to make hard choices. If we ever do it right, nobody will be happy with what emerges.
But we won't do it right. There's too much dirty fucking money in this game, and it ain't all (or even mostly) going to E-vil government, greedy doctors or freeloading patients. Trust me on this. And the political price for proposing substantive rational solutions of either the left or the right variety is too high right now. Nobody has the nuts to carry water for a completely free market system or a single-payer system. So we'll continue to limp along with the deeply fucked Frankenstein we have, sewing parts onto or hacking parts off of the devitalized corpse of the beast, and calling it "reform," for the foreseeable future. Plus ca change, plus c'est le meme chose.
I am an IT expert. I'm not trying to blow my horn here, but Information Security (InfoSec) is my livelihood. I've worked both in the private sector and in government. I've audited defense contractors, who supposedly have the best security controls in the world. I've worked for government agencies who say the same. I've also worked for fortune 100 companies. By far the best InfoSec controls are in place for the organizations that actually perceive the treat and have the means to pay for the controls. The government doesn't yet perceive the threat, they think they are invulnerable, and so are exploitable. Big business is starting to understand the ramifications of a breach but isn't completely convinced. Defense contractors are rock hard, as evidenced by the targeted attack against RSA and the follow up attacks on major defense contractors that were completely unsuccessful.
Originally Posted by Mark E. Hurling
If I had to entrust my electronic medical records to any organization it would be the insurance companies. They are the defense contractors of the medical world. They understand the risk and have the means to provide adequate controls.
Interesting to get your assessment given your broad range of experience. Defense contractors have indeed got robust protections because they actually implement the requirements the folks in the government and military mandate but fall short of doing themselves. Especially stateside in places like the Pentagon, who did get successfully attacked and not in a trivial manner. Of course once you get by that, the defense contractors' other operating elements are laughable in their protections, and that includes the parts that deal with medical records. I'm a physical/technical security type, AKA G3D (Gates, Guards, Guns and Dogs) with a nod toward the acoustic and RF spectrums.
Originally Posted by jdjohnson50
It's important to remember that, outside of the VA and the military, the government does not maintain medical records. Nor do they wish to. And no health policy proposal on either the right or left proposes that they should. Medical records, even those for Medicare and Medicaid patients, have been and will be maintained by providers, not the government, even if we were to go to a nationalized system. Nor do insurance companies maintain medical records, even in a completely market-driven system. At present, whether the patient is covered by private insurance, govt insurance or no insurance at all, records are maintained by providers--doctors and hospitals. This gets fuzzy when the hospital is owned by the insurance company, but I think you take my point. The idea that a nationalized system is going to result in your records floating around the internet due to govt malfeasance is a red herring.
In fact, it is govt legislation and govt monitoring (some of it pretty fucking draconian) that has led to increased privacy protections and fines for breaches. Getting into our Electronic Medical Records system at the DMC is something akin to James Bond getting access to MI6 headquarters. Even when I'm inside, it's for real: If I, a doctor, access the records of a patient, any patient, I'd better have a damn good reason for doing so, because that access is monitored. We fire people for accessing the records of patients without authorization or reason. We don't fuck around.
Any potential for loss or breach of electronic records is way offset by their utility, flexibility, and potential for improving patient safety and care (although I believe that potential is presently unrealized and overblown; EMR is in its infancy). And let's just suppose that a breach did occur, and health care information ended up in the open. WHo would abuse it? For the most part, it would be private insurers who would abuse it, not the government.
Sorry, but I really don't think this is the big problem with our system. We have much, much bigger fish to fry.
Last edited by Jonathon Sullivan; 09-17-2011 at 10:13 AM.
As a fellow physician (anesthesiologist) I commend you on your article. It really needed to be said. There is not a day that goes by where I don't anesthetize a patient who has a disease process that likely could have been stalled, reversed, or prevented altogether by Big Medicine.
I have forwarded this to several colleagues of mine.....
Thanks, Vivek, and all those who are helping to spread the word.
Originally Posted by vivek