Think Of It This Way ....

When I arrived at the lab, in this large new clinic building decorated with spectacular art work, it was 6:35 AM. Many of the chairs were filled and those that were empty were soon occupied by people waiting to be called for their tests.  Six or seven people lined-up at the intermittently-staffed lab reception desk.

You might not recognize this as cost-shifting, but in my opinion, it is.  Clinic management has decided that it is more efficient, in terms of their needs, to keep 18 people waiting for more than a half-hour each, rather than bring in phlebotomists to draw blood and instruct patients on how tests are to be performed.  Those patients, waiting for their blood to be drawn and specimens to be taken, were not at work, were not earning wages, and had just used expensive cars and expensive gasoline so that they could sit and wait and wait and wait.

When government and insurance companies calculate the costs of care, rarely are patient transportation costs and lost opportunity costs (not being at work earning a living) added to the equation. Those dollars come out of the patients' pockets, not the government or insurers pockets.  The cost has been shifted and no-one seems to notice or care.

So think of this as a cost shift and as an uncounted tax that each of us pays.

Your X-Ray & Your Doctor's Computer Monitor

In yesterday's blog, I discussed two physicians' abilities to display and review the same MRI, on their desktop computer monitors (and their different conclusions). On its face, this display technology seems efficient, appropriate, and without any downside.

But there is a downside, which will probably elude anyone who has not practiced medicine collaboratively with person to person discussion between two (and sometimes more) physicians reviewing an x-ray: a radiologist and the physician who ordered the study. When these physicians spend a few moments together to jointly review critical patient information (history, physical findings, lab, clinical impressions), they both benefit professionally because the study is no longer a solo cold intellectual exercise conducted in a dark room or reviewed in another country. The study becomes a source of information enriched by these physicians' collaboration. The radiologist can augment the ordering physician's clinical knowledge and skill, providing input which causes the clinician to modify his or her care of the patient.; the ordering physician can call attention to study findings that the radiologist may not have considered important but are clinically relevant.

While computer monitors on pysicians' desks may  show reports and scans, they do not provide the depth of information vital to the care of a patient with serious illness. Computer medical technology may provide the illusion of superior efficiency, but someone needs to study the real cost of  this application of non-collaborative technology..