American Elephants


The Social-Engineering Approach to Health Care by The Elephant's Child

John Goodman offers two fundamental ways of thinking about complex social systems: the economic approach and the engineering approach.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice.

Goodman, the father of the health savings account, calls this “cookbook medicine” which gives doctors rules and protocols for treating patients with various symptoms, and they must record each step along the way. Cookbook medicine does not bother with the differences among people, and is the opposite of personalized medicine which aims to tailor the therapy to the characteristics of the patient.

While it is useful to consider the standard protocols, people are not all the same. Medicine adapted to the genetic makeup of a person is in its infancy, but shows promise. When the cookbook becomes a rulebook to be followed slavishly, we’re in trouble. When complying with endless checklists takes valuable time away from patient care — that’s what’s happening in American medicine. A recent study of emergency room physicians found that they spend more time interacting with screens than patients, clicking the mouse 4,000 times in a 10-hour shift.

The Affordable Care Act was heavily influenced by the engineering model. After all, our bureaucrats are certified experts, and what are experts for if not to tell everybody else what to do and how to do it. Only social engineers would think of running “pilot programs” to control health care costs. What is the purpose of a pilot program if not to find something that appears to work, so you can order everyone else to copy it. Therefore you have the mess of digitizing all medical records and the result that hospitals have different systems that cannot talk to each other?

Dr. Virginia McIvor, a pediatric physician at Harvard Medical School explains the problem:

When a healthy child visits, I must complete these tasks while reviewing more than 300 other preventative care measures such as safe storage of a gun, domestic violence, child-proofing the home, nutrition, exercise, school performance, safe sex, bullying, smoking, drinking, drugs, behavior problems, family health issues, sleep, development and whatever else is on a patient’s or parent’s mind. While primary-care providers are good at prioritizing and staying on time — patient satisfaction scores are another quality metric — the endless box checking and scoring takes precious time away from doctor-patient communication.

If you have been to a doctor recently, you have probably noticed the multiplication of forms you must fill out, questions you must answer. I have noticed that the form now contains a line for “refuses to answer,” which may indicate progress of a sort.

John Goodman is the father of the “health savings account” which works precisely as promised and has been a great favorite. He is president of the National Center for Policy Analysis (NCPA) and he blogs regularly on health care matters (you can sign up to receive his columns), and his book Priceless takes on the health care problem.

There are great things happening in medicine that are promising for the future. The engineering rulebook is not interested in other people’s expertise or innovation.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
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