I'm a Family Physician, at, what many would call, the "front lines" in health care. I'm also a Vietnam Veteran, former Army officer, helicopter pilot and a graduate of West Point, Class of 1968. My reflections on health care cause me to reflect on Vietnam. How do the two relate? Both were non-declared wars. We won the major battles in both. We lost or are losing both wars. Why? How?
In Vietnam we were confused about the overall strategy, but our tactics won every major battle. One could say the same about health care. We have no overall strategy, but our weapons to fight disease are superb.
Morale in Vietnam deteriorated when front line troops were instructed to become killers instead of soldiers. Body counts replaced mission accomplishment as the focus. The troops found a way to hide from their role as "killers" in illegal drugs, from marijuana to heroin, and mental health problems such as PTSD.
Health care is starting to fade into numbers instead of patient care. Misguided quality initiatives follow IT installations in which billing software is modified into Electronic Medical Records (EMR)for clinical use, resulting in patients and their narratives being ignored into a sea of numbers. Nurses hang onto bar code readers instead of holding onto patient hands and hopes. Caring professionals are becoming despairing professionals.
Patients are being turned into numbers and bar codes. Their hopes and dreams, which should be the basis of "Quality" measures, are being ignored.
Robert McNamara, Defense Secretary for Presidents Kennedy and Johnson was the leader behind the Vietnam body counts which devastated troop morale. The Patient Protection and Affordable Care Act (PPACA), also referred to as "Obamacare", has now taken the lead with numbers-oriented policies and protocols that will move us closer to the demise of health care.
"Meaningful Use" (which I sometimes refer to as "Meaningless Use") is the term used to refer to the government mandates for approved Electronic Medical Records, which may reward primary care physicians with taxpayer dollars (up to $56,000 per compliant physician). The numbers game is polluting the push for developing the Patient Centered Medical Home (PCMH), which is supposed to help patients, into the development of, what I refer to as, "Payment Centered Medical Homes", with over-emphasis on physician reimbursement to try to "buy" medical students into Family Medicine and other primary care specialties.
Family Medicine is a relationship focused medical specialty. The patient-physician relationship is the heart of Family Medicine. It is our essence. It is being ripped out by the current direction of health care.
Is health care becoming another Vietnam, with massive expenditures and worsening outcomes? It feels that way to someone who's been involved in both wars.
What do you think?