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About 8 years ago I broke my leg and eventually developed a methicillin-resistant infection where screws had been inserted. Fighting this type of infection in t
by shrike 9y ago
About 8 years ago I broke my leg and eventually developed a methicillin-resistant infection where screws had been inserted. Fighting this type of infection in the bone is difficult. I spent 11 months in a hospital bed plus some time in a SNF. A total of 7 surgeries in the first 18 months and another 2 after that, the most recent 3 years ago.
I can second the experience of the author. All in I had contact with over 40 different providers. I was lucky in that I had to leave my job and could concentrate on the administrative work required full time. I eventually learned I needed to keep a detailed written narrative up to date with a tl;dr at the top. Eventually I added appendixes that summarized lab tests and surgery reports. This was the only way I could make sure each provider had the details they needed. I would always send it advance, most of the time the doctor hadn't read it so I brought paper copies and sat there while they did.
The billing and who covered what was hopeless. I had to fight with medical insurance, the medical disability company and Medicare when I maxed both of those out. I went through every bill line by line to identify mistakes, there were many. Then I would make sure each had received a copy of each bill and start figuring out who would cover what, sometimes line-by-line. This all had to be done over phone and fax.
It's broken and I am sure it's killing people. I also don't see a technology fix. Anything that requires more than two or three providers is an edge case, this space is 90% edge cases.
- lovich 9y agoIt sounds like the answer would be to standardize everything so that it wasn't 90% edge cases but there is no incentive for many of the players to do so
- nradov 9y agoStandardize what? With a complex medical condition like that every patient is different so it's tough to apply evidence-based medicine practices. The technology for sharing patient records is gradually being standardized. But that won't help if the doctors don't actually take time for a detailed review of the patient's records.
- trowawee 9y agoPersonally, from my observations as a software engineer married to a doctor and friendly with lots of doctors, and as an occasional participant in the American healthcare system, the general inadequacy of electronic medical systems is one of the most maddening aspects of our system. Epic is a monstrosity and none of the other systems are much better. The tech is outdated, the interfaces are awful, they're incredibly difficult to get to communicate with each other, and it sometimes feels like every single provider is using a different system that won't integrate with any of the other systems. It makes me angry as person whose doctors are using those systems (and it kinda scares me), and it makes me angry as a professional, because whoever the members of our profession are who are building those systems are doing a crap job.
- maxander 9y ago> whoever the members of our profession are who are building those systems are doing a crap job. They're doing an excellent job, probably producing a level of functionality comparable to Amazon web developers or Oracle database writers. They're doing an excellent job at navigating the unholy mess of archaic regulations, mismatching institutional requirements, and hostile corporate interests, without getting sued or convicted. User experience, or even user usability, is a secondary concern, since being difficult to use (even if this leads to multiple deaths per day) is in no way illegal. Medical informatics is definitely a field where smart and motivated people can make a huge difference to the world, and perhaps even get filthy rich while doing it. But it will take much more than a hotshot UX designer to work out.
- pnutjam 9y agoAmerican EMR systems are designed around billing systems. This is almost entirely the problem.
- knightofmars 9y agoYes, this too.
- conanbatt 9y ago> It's broken and I am sure it's killing people. I also don't see a technology fix. Anything that requires more than two or three providers is an edge case, this space is 90% edge cases. Vertical integration is the biggest hope. With vertical integration, there is no billing.
- 1_2__4 9y agoThere’s also no choice or incentive to improve.
- conanbatt 9y agoThere are plenty of incentives to help care and improve: the better healthcare you provide the less they cost you long term. Vertical integration puts preventative care in the scale.
- pcurve 9y agoi guess Kaiser Permanente is the closest to the vertical integration we're ever going to get here. I cannot wrap my head around how that would even happen in North East region with fragmented hospital systems. They would need to join together to form a single hospital system, and/or buy out primary care practices, then merge with a large insurance company and PBM.
- grecy 9y agoA few years ago my brother broke his leg horribly. The Ambulance drivers said it was the worst break they had ever seen. Multiple surgeries, months in hospital, rehab, got addicted to morphine in the process etc. etc. At the end of it all was a handshake and "get well soon". There was no bill. Australia.
- i_feel_great 9y agoMy father developed Parkinson's a few years back. Got referred to a specialist by his GP - it turned out to be the most senior specialist in the country. Waited a few days for the appointment, never saw a bill. In New Zealand.
- conanbatt 9y agoI broke my hand when I was a kid. The fragment of a bone was near a tendon and private doctors didn't have absolute consensus on surgery or not surgery for my case. A friend of my mothers worked in the ministry of public health. She got me an appointment to one of the most important hand doctors in the country. I went there and skipped a line of 100 people wanting to see him. He took a glance at my X-Ray and said there should be surgery with general anesthesia to prevent any damage to the tendon. There was also no bill.
- riverstones 9y agoI grew up in England. Same deal. In and out, no bill. The Americans who decry "socialist" medicine have never used it. There has to be a way to divorce health care and profit. English, Aussie, and Kiwi doctors all make about the same pay as American doctors, but they work in a non-profit system. Go figure... Americans are largely opposed to a system where there is no profit. The Americans are the Ferengi of medicine, this much is certain.
- deleted 9y ago[deleted]
- ido 9y agoAmerican doctors make 6 figures $/year, sometimes serious figures (like $400k/year). UK doctors don’t make near that much money.
- EvanAnderson 9y agoMore and more I am becoming convinced "killing people" is an intended "feature" rather than a bug. I'm sure it's not an explicit goal of any but a tiny fraction of participants in the "system", but, cynically, I am becoming convinced it is somebody's goal.
- jfoutz 9y agoI don't think it's on purpose. It's decomposing a monolith down to microservices, without any verification. Since each player is only responsible for their little corner of the world, no one actually has any sort of responsibility to ensure the overall system still works.
- faitswulff 9y agohttps://en.wikipedia.org/wiki/The_purpose_of_a_system_is_what_it_does https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_wha...
- dolson 9y agoEmergent behaviour.
- i_feel_great 9y agoI feel it is due to its complexity. The complexity is caused by rent seeking behaviour. I see shades of it here in Clay Shirky's essay: http://www.shirky.com/weblog/2010/04/the-collapse-of-complex-business-models/ http://www.shirky.com/weblog/2010/04/the-collapse-of-complex...
- xkcd-sucks 9y agoWell yeah, if something bad happens one can complain about it or figure out how to profit from it