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Wednesday, May 29, 2013

Massachusetts Law 2012.224.108

Wow. Think this idea will spread?

Commenter on THCB, where a post about this appeared.

Notwithstanding that I am a veteran Health IT advocate, this Section 108 law is a serious overreach. What if I'm a demonstrably competent and successful cash-only "concierge" clinician (they exist) who has no need of an MU certified EHR system?


“Patient-Centered” decision-making is a new buzz-word in medicine. It is a metaphor for a general approach to care that puts the patient’s experience and needs at the center, as opposed to the needs of the physician or the system.

While this is an effective marketing term, and a useful principle as far as it goes, as a guide to medical practice it is a bit simplistic. It needs to be viewed in the context of the overall medical infrastructure and the net effect specific practices have on the cost and effectiveness of medical care...

The optimal balance between the doctor, the patient, and third parties has been a longstanding debate within medicine. Thoughtful engagement on this issue, it seems, has resulted in real progress. The old paternalistic model, in which the patient simply did as they were told without meaningful consultation, has largely been replaced with a more cooperative model and one that properly grants to the patient informed consent.

Unfortunately, complexity intrudes on this comfortable relationship. We have to recognize that we are somewhat at cross-purposes. Optimal medical practice would maximize several outcomes simultaneously — the patient experience, doctor and patient autonomy, medical outcomes, and cost effectiveness, to name the most important. The problem is, you can’t always get all of these things to an optimal degree at the same time...
As usual, SBM commenters are astute across the breadth of perspectives.
There are all kinds of doctors, patients, and interactions between them. Some of the old so-called paternalistic docs of my childhood and early adulthood were wonderful, in the way Robert Young was wonderful as the father that knew best (even when he was being very paternalistic), and some of the new “patient centered” ones come off as automatons reading you your rights.

Now that my medical center is converting to electronic health records (which I thought I welcomed), all the docs just sit at the terminal and type, type, type, during the entire visit–no eye contact after the “hello”. I’m trying to adjust, and once asked her to just take notes and do it later. She complied but never did it again, so I try not to fuss.

More to come...

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