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Medical Paperwork, HIT and Generic Drugs


A number of often overlooked costs make health information technology more costly than expected. Plus, a survey of hospitals revealed that only a minority of employees would want to receive treatment where they work.

— In case you haven't noticed around the hospital cafeteria, doctors are fat, too. The Physicians' Health Study found in 2004 that 44% of us were so afflicted, and we know that obesity numbers have trended upward since then.

In a study of military medical residents — theoretically more fitness oriented than the rest of us — three years of training led to a four-pound gain. And we all know how things get worse with age. Some of the problems for doctors are in those hospital cafeterias, at medical meetings and, my personal pick, the steady supply of high calorie foods to be found in many of our break rooms. Especially around holiday time. Well-meaning patients and the evergreen "potluck" are visible culprits. What are you going to do about it, doc? How about a new office policy as a way to start?

— I see that the implementation of ICD-10 codes has been pushed back yet another year. Even the bureaucrats realize what a Gordian knot of a mess they are proposing to unleash upon an already overburdened medical community. Is this another case of a (misguided) solution in search of a problem? And whose bright idea was the ICD-10 anyway? As in most areas of government too, we need more transparency and personal accountability in all of our affairs.

— And while we are in the paperwork corner of the office, a series of overview studies — from McMaster and Indiana Universities, to name two — recently reviewed 36,000 (!) studies of medical information technology (IT) stretching back years and all came up with the same conclusion. In spite of vaunted predictions of dramatic cost savings, there are basically none to be found in IT to date — particularly when you figure in the overlooked costs of installation, training and maintenance. And the inevitable snafus and conflicts between competing and incompatible systems add another layer of delay and cost.

We are inevitably going in the electronic direction, if only for improved quality (read: legibility), research purposes and, of course, because we can. But we need to rethink this area from about 10,000 feet to get a bigger, more cost-efficient picture.

— After reading all of that, it is no surprise that a recent study reported in the Archives of Internal Medicine that 46% of all physicians experience emotional burnout at some time. Primary doctors run at an even higher 52% to 55% rate.

The article defines burnout as being stressed to the point of "exhaustion" and depersonalization of our patients. To which we may freely add depression, alcohol and drug abuse, irritability, ineffectiveness, relationship erosion and on and on. This is another one of those lacunae in medicine that we all see, or experience, yet we have little or no training to prevent, or help cope with, the problem. And such affliction can also be very expensive in lost income, employee turnover, malpractice activity and you can add more.

— We hear in the news that real estate is perking up in various areas around the U.S. I personally know one woman who told me that she sold her house in one week after receiving 28 offers!

The situation, apparently, is that foreclosures have peaked and there is little inventory left in some areas, so the supply and demand pendulum swings the other way. For those who want to sell in markets that are still tough, a report in The Wall Street Journal cites how the wording of your ad alone can affect your price and the speed of sale from as much as 10% lower to as much as 50% higher for both.

For instance, after looking at some 20,000 home sales, it was found that using the word "beautiful" led to an average of 5% more money and the house selling 15% faster. On the other hand, using the word "motivated" led to 8% less money and it took 30% longer! Human nature equates "motivated" with "desperate” and that means blood in the water and a lower, slower sale.

If you are looking to sell your house, make sure that your realtor knows about this study. It could turn out to be like free money — one of my favorite kinds.

— Generic drugs save the U.S. $1 billion dollars every other day, according to a study by the IMS Institute of Healthcare. That's $193 billion in 2011 and over $1 trillion in the last decade. Now if Congress would OK competitive bidding for the Part D drug benefit, our patients could save some real money.

— A recent Johns Hopkins survey of some 60 U.S. hospitals found when they asked employees "Would you feel comfortable receiving medical care in the unit in which you work?" more than half the hospitals said "no." Obviously this is not good and should not be ignored by hospital management, doctors and health care policy wonks.

How do you feel about your hospital's various units?

More later.

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Victor J. Dzau, MD, gives expert advice
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