This “illusion of certainty” certainly exists more for those outside healthcare than within.  Upon additional review of the Healthcare Reform Act, it seems to me that the authors have a different understanding of providing healthcare than currently exists.  Why else would anyone think that they poses all the knowledge and foresight to understand with clarity the eventual outcome of any specific act?

I just don’t get it.

According to the press release, the strike is over nurse/patient ratio’s (a measurement of the cost of working as an RN) and protection against threats to retirement (a benefit of working as an RN, and perceived benefit of working under unionization) which is dubious.

What will be missing from this debate is the incredibly onerous process someone has to go through to become an RN, and the fact that nurses insist on doing everything themselves.

I know first hand how difficult it is to work as an RN.  It’s hard work physically and emotionally, and I continue to have great respect for those who continue in the field.  Still the training to become an RN, is difficult and expensive, though the exam to become an RN is not.  I just spoke earlier with a woman seeking to be an RN with a 3.4 GPA and who can’t get in, clearly something is wrong here.  I know it’s expensive to train an RN, but this is fixable when we have qualified individuals eager to enter into the field, but no room.  This can be fixed.

Secondly, RN’s need to be able to relinquish tasks to others.  I recall many times working in ICU when we’d have two to four highly trained RN’s in a room, just trying to get a patient out of bed.  Clearly, this task didn’t require a team of all RN’s.  I often wondered how much easier it would have been for the hospital to go to the local Golds gym, and hire a few guys with no neck to work a few hours helping with the heavy lifting; just how much do you need to know to do that?

It will be very interesting to see how this plays out, still it’s only the beginning.  With the median age of RN’s approaching 53 years old, it doesn’t take a great deal of math to see that we have a problem in front of us which requires significant thinking and lots of leadership.

Thomas A. Coss, RN

The downside of pen and paper is that the information contained on paper doesn’t aggregate well.  You can’t look back through it easily to assess what works and what does not.  In earlier days when a family physician took care of you from cradle to grave, it wasn’t a problem; as long as the physician stayed alive, he or she was a biologic historical database of what went on in a patients life.  Today, however, with highly specialized and fictionalized care, it’s a problem.  So why not the sluggish acceptance of EHR’s in the private sector.

To the casual observer the perception is that costs are real, and benefits vague.  These excuses are self-damaging and weak minded.  Time to get busy.

In this piece regarding Electronic Health Records and Clinical Trials from Chris Thorman of Software Advice speaks to one legitimate benefit often talked about, but seldom realized.  True, the use of practice data in clinical trials is limited, but it’s not zero, and it grows over time.   Identifying subtle changes in treatments over time, or simply identifying patients for whom detailed clinical studies are appropriate, will contribute to improving efficiency of bringing new drugs and treatments to market.  In so doing, a faster path to market results in a longer period under patent protection, and higher product lifetime valuation with lower costs.

In the end it looks like this: the medical practice of the future needs to begin now to design itself toward increasing  its efficient and percent of total annual revenue from cash.  This means providing services for which patients will pay cash along with discovering new means by which practices can contribute value and receive compensation outside the existing constraints of third party payment.  This includes EHR’s, but also means a way patients can create appointments on their own schedule 24/7, along with a means by which medical practices can keep in closer communication with their patients.

There is no stability or efficiency in health care without successful and vibrant medical practices.  It’s time for every practice to find an EHR that works for them and put it to use, along with systems and processesto build and manage closer relationships with their patients.

So this weekend, listen to those quiet men and women who “do not need to raise their voice” as they lay upon the united states economy the a new bondage of entitlement.  They will feel so good, and warm and pleased with their actions whose results will choke the oxygen out of our economy, crowd out investment, money for your child’s education, and make us all poorer.

I’m not suggesting that the democrats are knowingly inflicting harm, though they are, but the reward to them in passing this legislation without full regard to its impact, is suspicious.  They are so looking forward to the signature parade at the White House, that they can’t see past the process.  In the legislative sense, this is MSP at its worse.

The U.S. jobless rate for October  jumped up 0.4 percentage point to 10.2%, the highest level since April 1983. The government’s broader measure of unemployment shot up even more, rising half a point to 17.5%, still with this in front of them, the democrats insist on pushing through their vision of reality.  The democrats are driving this train past all the alarms and warning of dangers ahead, and we’re stuck facing the results of the inevitable derailment.

This future is sad, easily predictable, guaranteed to get worse and fundamentally unnecessary. Perhaps  this will help:

Presume for a moment that you have a headache because someone is beating you on the head with a stick; you can: a) take medication for the headache or b) take away the stick. The government chose “a” (pass a huge healthcare bill and taxes to support it); I recommend “b” (lower the tax burden, don’t add to it, and free up capital investment in healthcare by reductions in capital gains.) By no means should the government be messing around in an industry of which they understand little, that was responsible for 56% of US job growth from 2002 to 2006, and an industry in which America has a strong comparative advantage that doesn’t outsource well.

Healthcare is complicated, as an RN, I can assure that is true beyond anyone’s imagination.  Should the House and Senate bill come into law in any fashion as currently seen, we are in grave condition indeed.  We all need to begin doing all we can to stay as healthy as possible, because should you get sick, the last thing you will want is healthcare.

Tom