Alt-Health: Assume Nothing

One of my favorite literary quotes is from Stephen King’s, Cell, a gory tale in which most of the US population is turned into zombies by a frequency transmitted via their cell phones. Shortly before getting her brains bashed in by a lurching humanoid, one of the few remaining survivors says, “Don’t ever assume. ASSUME makes an ass out of you and me.” It is an apt epitaph to the expectations with which many approach our newly digitized health system.

One of the most common assumptions that we have when we walk into an exam room is that the doctor already knows everything about us. Hey, we just spent 20 minutes filling out forms with every intimate detail of our insurance and health history! We’ve filled out forms with every specialist we’ve seen; we know the data is in their computer. The doctor we are seeing now has access to all of that, right? Wrong.

Although most of us can now find everything from worldwide airfares to criminal histories on our phones, up until recently, the medical system remained a dinosaur mired in a swamp of paperwork. Prescriptions and test results were faxed from office to office, patients’ histories and treatments were copied, filed and stored en masse by companies that specialized solely in medical records. An entire industry was built around it, which may be one of the reasons that it’s proven tricky to get rid of those hard copies. Lord knows, the Obama administration tried.

One of Obama’s first priorities when establishing the Affordable Care Act was to bring our medical system into the 21st Century. Twenty-seven billion dollars were assigned to changing the paper system to a digitized one. Unfortunately, even Obama considers it one of the biggest failures of the ACA. The transition from paper to digital data has caused as many problems as it has solved. What should have been an efficient system linking and coordinating patient information between various health care providers has turned into a complex and confusing maze.

Every doctor enters data into their own system. The day of the lone practitioner is past, and most physicians are now employees of larger medical groups housing many caregivers under the same roof. Each patient becomes digitized, converted to electronic data and stored in a virtual silo. That data stays within that medical group’s system. Patients now have access to their own online portals where, with a password, lab results and doctor communications can be accessed. It gives a sense that the information is readily available to every doctor we see. But it is only visible to the patient and his doctor in that particular office. If a hospital or specialist wants that information, they have to request it. Specialists are supposed to send records from a patient’s visit to the primary care doctor in charge, but as often as not, they don’t. Labs should send all test results to both the specialist and the primary care doctor, but it doesn’t always happen, and unfortunately, office to office cooperation is not insured under Affordable Care.

There are some practical, albeit self-serving, reasons for hospitals and doctors to balk at sharing. Yes, it would be great for the patients. Any doctor in any office in the country could instantly view past and current medical history and test data, making it much easier to get a second opinion. It would also make it easier for a patient to change health care providers. Oops. Few physicians want to streamline that particular freedom of choice.

In fact, you won’t find many doctors who are crazy about the new digitized system to begin with. It has turned their job into one that is dominated by data entry. Fully half of a doctor’s time with a patient is spent typing notes, checking boxes and figuring codes. The codes cater to the convenience of the insurance companies and administrators, certainly not to those of the physician, who gets a much clearer idea of what’s wrong with the patient by talking to them. Now, literally every symptom or condition a person can have is covered by codes. There are even multiple code variations for hallucinations; the only condition that isn’t allowed for is that of being well. There ain’t no code for “perfectly healthy.” The insurance companies can’t make any money off of that.

If there is a lesson to be learned here, it is this: When it comes to your health, don’t ever assume.Your doctor is educated and experienced, but she or he is not an omnipotent, all-knowing being. It’s up to you to give clear, accurate information about any condition you have, and to be honest about all of your extracurricular activities. It all has a bearing on diagnosing your problem, and the doctor isn’t going to know if you don’t speak up. When it comes to your health, the idea is to save your ass — not be one.