Medical science is advancing rapidly. CAT scans, new antibiotics, Viagra, Flintstone vitamins…all modern wonders for sure. But as a physician, I believe the most amazing medical advancement in the past fifty years is the "prior authorization".
For you non-medical readers, a prior authorization is something you need to get from the insurance company before attempting anything of a medical nature. The reason this system works so incredibly well is that insurance companies employ highly trained third-graders to tell physicians whether they can order tests, surgery, or Band-Aids for our patients.
The way prior authorizations work is as follows: The physician calls the elementary school student manning the phones that day, and is put on hold for about an hour. If this sounds like a bad thing, I will point out that while waiting, you can often listen to several songs by famous artists like Barry Manilow.
Eventually, the little tyke on the other end of the phone comes on and tells you that no, you can't do whatever you wanted to do. The entire process has been honed into an efficient and soul-killing system.
But with every new technology, there are pitfalls. We medical people used to write everything down on paper. It was a simple system, and you could tell what you were in for by measuring the thickness of the medical chart. If you saw the nurse hoist a chart the size of a Webster's Dictionary into that plastic holder on the exam room door, that was the one you walked past, leaving that patient for the other doctors to see. I loved paper charts.
Then somebody invented the electronic health record. Now the doctor could sit behind a laptop and stare at a computer screen instead of actually looking at or interacting with the patient. This was quite an improvement, of course, but the new system was not without its problems.
Many different computer nerds were competing for the electronic health record business at the time. These nerds must’ve all had a wicked sense of humor, because none of the systems could talk to one another. Like a United Nations General Assembly meeting, confusion reigned. One medical office couldn't simply hit a button and send over the patient's records to another office.
Luckily, most medical clinics employ a large cadre of young workers who might, if they’re not busy checking their email, put their phones down long enough to print the medical record, then fax it to the other office. The whole process can take up to several years.
My main objection to electronic health records is that, at some point, every one of them asks the same question: "Have you counseled the patient about smoking cessation?"
Well, no, I hadn't. For some reason, this annoys the electronic health record so much that it refuses to let you continue. You quickly learn to just go ahead and counsel the patient on smoking cessation, as illustrated in this entirely fictional example.
Me: Tell me, Jeffrey, how many packs of cigarettes do you smoke a day?
Patient: I don't smoke.
Me: Well, you really should quit, you know.
Patient: But I don't…
Me: And don't lie. I used to tell my doctor I only smoked half a pack a day, but I really smoked a whole pack most days. So come on, tell me the truth. Is it a pack a day? It's really a pack a day, isn't it?
Patient: Mom, why is the doctor being so mean?
Patient's mother: Doctor, is this really necessary? Jeffrey is only six years old.
Me: Yes, Mrs. Smith. According to my computer, it is very, very necessary.
It is possible that this system will root out the occasional kid sneaking a couple of Marlboros on the playground. I suppose the people who wrote all the electronic health record programs put a lot of thought into this important health issue. Not only is smoking bad for your health, but it takes up valuable time when our children could be manning the insurance company phones.