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.

**

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.

 

serious, trivial, comical, sarcastic … and in no order whatsoever!       

*President Biden can shrug off kids being slaughtered, saying “I can’t do anything about it.” Meantime he is attempting to cancel student debt by using his executive authority.

*Is it fair that snow should be white, completely absent of diversity?

*Will the United States Constitution be declared null and void, given the profiles of its writers?

*Why should a King beat a Queen in cards?

*No replays of controversial decisions in any sport should last more than two minutes. If no change is agreed upon within 120-seconds, the original decision stands.

*If Trump goes to jail for paying a porn star, will Hunter Biden be his roommate for his legal infractions.

*NILs bring honesty to the corrupt business of college athletics.

*Baseball rule changes have made it almost impossible to read a novel between pitches.

*Advertising is now sometimes seen between foul shots in basketball, serves in tennis, and VAR decisions in futbol … and everywhere else.

*Gambling is omnipresent; what are the odds that I will finish this bit of inspiration and post it.

*Ya gotta love it. The “New York Times Sunday Magazine” brings tears to your eyes with its article on yet another social ill, with the extended essay interrupted by ads for multimillion dollar condos.

*Why is an athlete incurring a debilitating injury treated as a hero while a company employing hundreds of people is frequently regarded as an exploiter of people and the environment … and a tax cheat.

*If referring to a person with excess poundage as being f… is no longer permissible, can we mention rates of diabetes or heart disease.

*Many years back, I proposed a series of rules for soccer in order to increase its appeal to points happy, immediate gratification Americans. Suffice it to say, nothing happened. And yet the American soccer league, MLS, has grown in popularity, not because of open immigration but because millennials have adopted it as a nice social experience, more wine than beer in nature. Fearing that this current love affair may not age well, I hereby propose changes exclusively geared to points. (Please don’t throw things – even Pique wants some alterations in his lifelong sport.)

Run-of-play goals:   2 points; 3 points if the shot is taken from beyond the 18-yard box. Like the NBA. Penalty kicks: 1 point. More than half the time, penalties do not reflect clear-cut referee/VAR decisions.

*The Premier League, among others, has a system called “Relegation.” It basically says to a bunch of poor teams, get away from us, become better, and maybe you will have a chance next year to play at our level. Typically, the managers, aka coaches, are fired. Wouldn’t this be a good system for all major sports, both the relegation and the automatic firing. Think of the reduction in sports talk radio nonsense as the talking heads no longer would need to speculate about both the team and the manager.

*How does it happen: Democrats, supposedly home to all minorities, continue to receive large funding from teachers unions which act against the educational interests of minority children.

*Is hypocrisy better than no values at all!

*I forget, what is the latest scientific finding – is coffee now okay and wine not, are both okay if accompanied by incredibly dark chocolate?

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This is a compilation of my monthly Birthday Cards in 2022. The various boxed designs have been deleted and the verbiage has all been made flush left for consistency. Differences in fonts remain.

Each was originally signed, “Peace, Bob.”

JANUARY:

Other than Three Kings Day, what jumps out about this opening month of the year?

Maybe I should be personal: my granddaughter  becomes a teenager. Nice, and a touch scary.

Of course, she is not the only great person

who has a birthday in January!

In the cold weather climate where many of us reside, there is inevitably the challenge of ignoring the temperature and the white stuff, and instead, to regard it as “invigorating.”

The presence of Omicron is a downer, bringing with it renewed demands on all frontliners, which include not only those in health and education, but workers in less public but totally necessary jobs like food service.

Declare victory in whatever circumstance

 is relevant to you and celebrate!

FEBRUARY:

HAPPY BIRTHDAY!   Leaving out of any conversation

the subjects of cold weather, snow, difficult driving conditions,

and aching muscles from shoveling,

February is the month of LOVE.

LOVE is of such profound importance

in making sense out of life

that the word should be used often with

family, friends, and romantic partners — regardless of their labels or circumstances, their triumphs or failures.

LOVE is there

before, during, and after Valentine’s Day

and before, during, and after this,

your very special day.

HAPPY BIRTHDAY!

MARCH:

“Spring has sprung, the grass has ris’

I wonder where the birdies is!”

Ignore the grammar errors – it’s

the thought that counts. Besides,

I hear that many professors

no longer care about whether

a person can write; it is enough

that the student “gets” the material.

Anyway, hopefully this particular Spring is not a masked invader

and enemy of our

deep desire for normalcy.

The undeniable good news is

that March has brought you

a BIRTHDAY, so make it a HAPPY one.

APRIL:

President Biden has made it clear:

“somebody should take out that a..hole Putin.”

Former President Trump recently tweeted:

“I am sorry I said all those awful things about so many people. It will never happen again.”

Upon reflection, Pope Francis has acknowledged that one cannot be neutral about murder.

He now condemns whatshisname.

After being scolded for his many misstatements, President Biden has announced he will step down. Vice-President Harris, who has been clamoring for this action, will take the reins.

OK, all of the above was written on April Fool’s Day.

What is real is that today is

your Birthday – make it a joyous occasion.

MAY:

May is a cornucopia of sports: the NBA and NHL play-offs, the Kentucky Derby, major league baseball, and the NFL draft.

Which leads to a trivia question aimed at professional sports geeks: when was the last time that simultaneously the football selections of both Giants and the Jets were well received and both Yankees and Mets were playing really well. Maybe never.

If you could care less about sports, you have to like May’s weather, plus Mother’s Day,

Cinco de Mayo, and Memorial Day.

It’s not a bad month to have a birthday,

so ———- make it a HAPPY OCCASION!

JUNE:
PRAY FOR GUN LEGISLATION

June is upon us.

Time to go to the beach,

play some volleyball,

read a trashy novel,

ignore social media,

have a legal beverage,

and maybe contemplate

the meaning of life.

Happy Birthday!

PRAY FOR GUN LEGISLATION

JULY:

Celebrating July 4^th and the

beginning of Summer

seems a muted enjoyment:

inflation, looming recession, war in Ukraine, and, worst of all,

the continued slaughter

of our children.

Sorry to be a downer, but a visit to Uvalde or Buffalo or …..

will do that to a person.

For this day though,

immerse yourself

in the joy of being alive.

HAPPY BIRTHDAY!

AUGUST:

August is a month with little personality.

It’s devoid of holidays. Some view it as a time to bemoan the prospective

end of Summer.

In hot weather states, the school year begins mid-August. People there do not experience a real change of seasons.

Advantage: New Jersey!

In any case, there is no reason to waste time lamenting the blandness of August.

Go to the beach, play some volleyball, swim safely, read a book, barbecue something delicious, and have a legal beverage or two.

HAPPY BIRTHDAY!!!

SEPTEMBER:

STOP THE PRESSES: A WHOLE LOT OF STUDENT DEBT IS SCHEDULED TO BE CANCELLED !

Moving right along –in contrast to August,

a normal September is a busy month:

*colleges back in business,

overcharging for their product

*football returning,

bringing future head problems

*the baseball season heating up,

while the air cools down

*Labor Day poorly observed,

but interest in unions is rising

*Pop-up stores already pushing

Halloween stuff, irritating parents

Regardless of your participation in any

or all of the above, take significant time

to celebrate: especially if your debt will disappear.

It’s your BIRTHDAY!!!   

OCTOBER:

If you fly to New Jersey from the West Coast in the middle of that particular October night when the clocks get turned back an hour, the West-East clock gain is offset for an hour by the Daylight Saving Time shift.

Does this mean that effectively time did not exist for those vanished 60 minutes? I’m confused.

If time can be changed by passing a law, couldn’t states become innovative. Maine could make a big enough time change to delay the onset of winter. California could shift its clock enough to reduce the period of warm weather, thus reducing its attraction to the homeless population. Texas could change its clock on election day to prevent unwanted voters from getting to the voting booth.

The possibilities are endless. Is time nothing but an accountant’s way of looking at reality!

Other societies treat time quite differently.

For example, the French reportedly consume the same number of calories as Americans, but they do not have our obesity problem – the apparent reason is that they eat in a leisurely fashion, not rushed as is our norm.

There is one timeframe which is unalterable – it is that of  your special day: HAPPY BIRTHDAY!!!

NOVEMBER: 

November seemingly is centered around Thanksgiving, even though it comes late in the month. By the time the date rolls around, the trees have shed their colorful leaves, perhaps embarrassed that they have been such show-offs.

I think about Turkey Day a lot, always putting in my request to have

creamed onions, which nobody else will miss

when they are not on the dining room table … again.

Was it a group of border crossers who started this ritual all those years back?

What progress we have made – maybe. Sad that often families come together at Thanksgiving more out of a feeling of obligation than love. There frequently is an unspoken agreement that politics are not to be discussed, a resolution which is broken sometime between the drumstick and the third glass of wine.

Speaking of implicit obligations, all red-blooded males in America

are expected to dull their senses not just with alcohol

 but with endless hours of football watching.

With shopping only hours away from the annual mayhem at Walmart,

women with sharp elbows and steely determination

are plotting their Black Friday strategy.

Grandma is ostensibly the ringleader of this whole affair.

When she mishears “pass the peas” as “pass the peace,” she immediately

hugs her nearest mortified grandson while others wonder what is going on.

When it is time for the fun and games, overeating, and excessive drinking

to cease, everybody is on their best behavior,

silently congratulating themselves at not having attacked those

who believe they have all the answers to the ills of the country.

Regardless of the details, have a HAPPY BIRTHDAY!

DECEMBER:

A friend has accused me of frequently

putting “dark thoughts” in these cards. Apparently she dislikes sarcasm

or a spotlight being shown on hypocrisy.

So I will set the record straight.

I think this is a great time of year –

and if I was a Chinese exporter,

I would like it even more.

It’s equally awesome that we get to demonstrate our belief in a higher power,

the God of Consumerism.

Seriously, I am fond of December,

the Holidays, the camaraderie.

Honest …. Really …. Absolutely

HAVE A HAPPY BIRTHDAY –