Portals and Moral Injury
It was inevitable.
When my local physical therapy company was sold to MegaTherapy, Inc., the first order of business was a requirement that I fill out a patient portal. So now I will vent.
Could somebody demonstrate how the corporatization of healthcare, here represented by information portals, has contributed to patients being healthier? The incessant drive for efficiency, as measured by units of service, adjusted for value as determined by MegaInsurance, Inc., has depersonalized the relationship of healthcare provider to patient.
My primary doctor is in a small practice. Any errors regarding the portal are of no consequence to either her or her office as administrative and financial functions have long since been outsourced – for efficiency of course. It took me a year and a direct conversation with a corporate computer geek to get information deleted which indicated I was seeing a pediatrician!
Speaking of my primary, I am unsure: can her input on my meds be overruled by MegaPharmacy? When I go to pick up my drugs, can MegaPharmacy both inform me that the manufacturer of X is shutting down the product line and render an opinion that Y is basically the same drug – without any discussion with the doctor?
Patient portals plus outsourcing of everything possible combine to sever the desired holistic relationship among the healthcare provider, their office, and the client/patient. Instead of being concerned about the effectiveness of healthcare, the system is fixated on efficiency, the latter a term highly correlated with immediate bottom line enhancement. If you go through all the layers of healthcare, an observer might conclude that It is beneficial to the “medical-industrial” complex for people to remain sick.
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I am always challenged to convince my perpetually skeptical daughters that the old man actually is not alone in his critique of healthcare, even if portals are not exactly the focus of any debate.
Consider the following points and ask yourself: do they make you more or less comfortable as a patient?
From a lengthy article in the New York Times Magazine of June 18, 2023:
- 70% of doctors are salaried employees of large hospital systems or corporations
- 30% of the staff in emergency rooms are employees of private equity firms
- Emphasis on speed, efficiency, and relative value units (RVU) encourages more tests and procedures while discouraging listening and talking time with the patient.
“Doctors must operate with a clear sense that they are serving the patients in front of them, not the government, data-collection systems, insurance companies, or hospital directors.” The overall result when they cannot do so is called “moral injury” (a term coined by psychiatrist Jonathan Shay), afflicting healthcare personnel who are unable to provide what they believe is medically appropriate service.
To be fair, there were two positives cited in the article: modest growth in the number of doctors who are providing direct service and a lawsuit in California against a private equity provider of healthcare, which seemed to be in direct violation of a state statute.
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More ammunition for those who wonder about healthcare delivery comes from a Wall Street Journal article of December 30, 2021: “The Doctor’s Office becomes an Assembly Line.”
According to the author, Devorah Goldman, in 2018, 46% of doctors owned their practices, down from 75% in 1983. For the first time, less than half of doctors work in private practice. Kathleen Blake, AMA vice-president of healthcare quality was quoted as saying that “hospital acquisitions of private practices doubled from 2012 to 2018, the result being modestly worse patient experiences and no significant changes in readmission or mortality rates.”
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Healthcare ownership trends are particularly untimely because demographic change will bring more minorities into the ranks of doctors and physician assistants in particular. Minority patients will seek them out and want to interact longer than the standard insurance time allotments. Research on socioeconomic determinants of illness adds to the logic of medical personnel needing more time with patients, not less.
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As one critic put it, “doctors no longer see patients, they see pathologies.”
In time, perhaps there will be an informational implant on our arm and a bar code on our behinds — they will provide patient information to the anonymous medical staffer who will then click on the correct box under robotic procedures –simultaneously sending the billing code to MegaInsurance. Before you get to your car, your portal will have pinged you with the cost of the procedure. Payment due in thirty days.
Very efficient!
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Did I mention that my password at MegaTherapy is “Iloatheportals.”
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Yes, I am ignoring the impact of AI/ChatGPT. Maybe on another day, I will tackle the complexities it brings to healthcare. Or not.
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Not to be negative, but according to the World Health Organization, the United States is less safe than Russia in terms of its maternal-mortality death rate: 21.1 per 100,000 live births versus 13.7 in Russia.