It's About Time

By Kim Bellard, February 16, 2018 Chances are, the sun isn't directly overhead for you when it is for me.  That's why for most of human existence time was a local matter. Nowadays, we have time zones that span the globe, and we have clocks so accurate that satellites have to take into account relativistic time-dilation effects. Technology made the change possible, and necessary.  Health care should learn from this. It used to be that local time was good enough.  The village clock served your purposes.  It was the railroads that made this impractical.  People wanted to know when trains would arrive, and when they'd leave.  More importantly, if they weren't coordinated, trains traveling in different directions might -- and did -- run into each other. We treat health care much like we used to treat time. That is, it is largely local.  How it is practiced in one community may not be how it is practiced in the next community, or even the next hospital or physician practice within a community. .  The care you get will depend on, of course, what is wrong with you, but also on which physician you see.  Very few dispute that there is significant variation in care, or that it is probably bigger than it should be.  But there's not much evidence that it is getting any less.  We accept these variations because, well, that's how it has always been.  We accept them because we think our personal situation is unique.  We accept them because we trust our local experts.    We accept them for all the same reasons we used to accept that time should be local. Technology has made it both necessary and possible that we move away from this attitude. It is necessary because the scope of the problem is clear.  As Propublica put it in a recent expose of unnecessary procedures: "Wasted spending isn’t hard to find once researchers — and reporters — look for it."  Almost twenty years ago the Institute of Medicine estimated as many as 98,000 hospital deaths annually due to medical errors.   More recently, medical errors have been estimated to be the third leading cause of death in the U.S.  Yes, moving away from "local" health care is necessary. The good news is that it is possible.  We have the technology to consult with physicians who don't happen to be local, such as through telemedicine.  It is possible to get the "best" doctor for our needs, not just the closest. We have artificial intelligence that can analyze all that data plus all those medical studies that no human can possibly keep up with.  It is possible to come up with the "right" recommendations for us.    We have to stop thinking of health care as local.  The information it is based on is not.  The people who are best able to apply that information to our situation may not be. If I get a driver's license, I don't have to get another one when I drive to another state.  If I get on a plane, the pilot doesn't have to have a pilot's license from each state he/she lands in, or flies over.  But if I want to use a doctor who is in a different state (or country), that doctor needs a license from my state.     We've always justified such licensing by states wanting to ensure the safety of their citizens, but drivers and pilots can put those citizens at risk too.  It's not really about risk; it's more about controlling competition.  There is irrefutable evidence that local health care is rarely what is going to be best.  It might not be bad care, but most likely it's only going to be average.  Maybe we're willing to settle for that.  I'm not. Time for a change. This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting