Viewpoint

Caution and Paper Aplenty

Larry E. Patterson, MD

Now that the election has come to pass, one fact remains constant despite the outcome: Central planning does not work.

Our profession has, to its credit, made quantum leaps with evidence-based medicine. Remember when we patched all corneal abrasions? It made sense, but it turned out it really wasn’t that helpful. I haven’t patched an abrasion in two decades. We used to get full blood work, urinalysis and chest X-rays on cataract surgery patients. Studies showed they had no effect on outcomes. We stopped doing them, saving the health-care system hundreds of millions of dollars a year.

Now, governments and accrediting agencies are asking us to do more and more with no evidence to support them.

Medicare recently started mandating full H&Ps on all patients having surgery in a ambulatory surgery center, even for YAG laser capsulotomies. Besides the inconvenience to the patient, the cost is phenomenal. Multiply millions of surgeries times the cost of a physical.

We must now re-examine our patients the day of surgery, and the surgeon, rather than his or her trusted nurse or assistant, must personally mark the eye. Is there any evidence that this actually makes any difference in outcomes? Has anyone done a study to see if PQRI reporting actually improves patient care?

My office was fined $13,000 (reduced from $30,000) by our state OSHA because an arrogant inspector who felt he needed to prove something didn’t like some of the things we were doing, although they were perfectly safe. (Maybe he was overcompensating for something that happened in his past.)

And wouldn’t it had made sense to at least try ObamaCare in a small region or in a five-to-10-year pilot program and see what the true costs and effects would be before going nationwide?

I won’t belabor electronic health records, but look carefully at all the “meaningless use” requirements. Very little, if any, data supports that EHR and all the accompanying government requirements are anywhere near cost-effective. My patients don’t really want us to waste paper on clinical summaries they can’t understand anyway. We use far more paper with our “paperless” computer system thanks to government mandates. With Stage II of “meaningless use” looming, this will only get worse.

Which leads me to the recent meningitis crisis where people all over the country have been infected by a contaminated drug from a compounding pharmacy. In the past, we safely mixed, not compounded, sterile eye drops for our own use before surgery for patient and staff convenience. However, central planners told us this wasn’t safe, despite overwhelming evidence to the contrary.

So now I’m told that, since I obeyed their edict, I must now inform and needlessly scare my patients, several hundred of them, that they may have received tainted drugs and need to be monitored carefully. This is being done, to quote the government, “out of an abundance of caution.”

Well, dang it, that’s what got us in this mess to begin with!