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Healthcare Consumerism: The Emperor Has No Clothes

The only products manufactured and produced by the health care industry by doctors, hospitals, therapists with their patients are clinical outcomes. There are only 4 products manufactured and produced in health care, these are preventative, medical, surgical and palliative outcomes.

Truth in health care advertising and marketing would dictate that claims or advertising regarding doctors, hospitals, Retail Clinics, therapists, diagnostics, treatments, and devices would discuss the price and quality of preventative, medical, surgical and palliative outcomes produced by doctors, hospitals, therapists or devices with their patients.

If you examine advertisements regarding these manufacturers of clinical outcome products, you will never see any claims regarding the quality or price of these outcomes they produce. Open an in-flight magazine on an airline, examine a billboard on a highway or an ad on the internet, all you’ll see are smiling caricatures of handsome doctors in white lab coats who claim to be the best, but offer no proof regarding the cost or quality of their product (outcomes) relative to other doctors, hospitals, and therapists to verify that claim.

For almost 2 decades, I’ve been included in something called the Castle Connolly book of ‘Best Doctors’. Am I truly a “Best” doctor? Is this based on my clinical outcomes? The answers are respectively; I have no idea if I’m a ‘best’ doctor, and no. This is not based on any analysis of the cost or quality of the clinical outcomes I produce with my patients.

Some will claim that online reviews by patients such as on Health Grades, or Zoc Doc are a true reflection of the quality of medical practice or health care delivered. Clearly these online non-scientific or statistically inconclusive ‘polls’ say more about the individual patient, and demonstrate no evidence regarding the quality or price of the short or long-term clinical outcomes produced by that doctor with that or all his or her patients. Poor 85 yo Mrs. Jones suffered a debilitating stroke, however, thanks to wonderful care delivered with the patient, she recovered full function but was too involved in her rehab and had no access to the internet to post an online comment on Zoc Doc or Health Grades. If a doctor with bad bedside manners operating in a hut in Zambia with dirt floors demonstrates higher cure rates for cancer and lower morbidity and mortality for diabetes than his or her peers at a lower cost, the world would beat a path to his or her door, but he or she may get trashed online due to the dirt floors, body piercings of the receptionist or two hour wait without air conditioning.

As an empowered patient or a healthcare consuming patient, there’s really only one place to turn when shopping for the best doctor. Only by examining the quality and cost 4 clinical outcomes produced by a physician with patients according to all variables for a particular disease or group of diseases and comorbidities can a prospective patient or even other doctors chose who is best.

The insurance, pharmaceutical, EMR and pharmacy industries have been privy to this personal chart outcome data for decades bartering selling and trading private patient healthcare information for profit. Insurance actuaries don’t like to guess. Wouldn’t it be nice if patients and physicians wouldn’t have to guess regarding who are the best doctors and hospitals, and most importantly why they’re the best? The physicians who produce and manufacture clinical outcomes with patients have been prevented from access to this outcome and cost data.

There’s only one way to tabulate and reveal clinical outcomes and costs and that is through the standardization and integration of interoperable electronic medical records (EMR/EHR) and billing systems. The ability to digitally examine clinical outcomes according to all variables has existed for over 2 decades, think Excel think Blockchain. Unfortunately, the insurance, pharmaceutical, med mal, adademe/publishing, Hospital and EMR/EHR and billing industries together with their patron politicians have prevented the establishment of interoperable EMR’s due to the potentially devastating effects of revealed outcomes and costs on those 6 ancillary health care industries.

Next time you witness marketing or see an advertisement relating to the doctors, hospitals, therapists, medications, devices or apps which manufacture and produce preventative, medical, surgical and palliative outcomes with patients, ask yourself if there is any proof being presented that their outcomes are better than their competitors. Wouldn’t everyone like to know which doctors, hospitals, therapists, drugs or devices have the best and most cost-effective clinical outcomes for which diseases and why? Wouldn’t everyone like to know what insurance companies have the best clinical outcomes and associated prices for their insured customers? Wouldn’t everyone like to know what is the highest quality and lowest cost drug for which diseases and why? Wouldn’t everyone like to improve under-performing doctors and hospitals via capitalistic market competition based on outcomes instead of simply suing his or her scrubs off?

Wouldn’t everyone like to see advertisements in newspapers, billboards, in-flight magazines and on the internet for doctors, hospitals, therapists, pharmaceuticals or devices which state that their quality and price AKA: VALUE is best for certain diseases and patients? Wouldn’t everyone like to know if the VIP or Concierge practice industry delivers improved outcomes justifying the costs? It’s time to end empiricism in health care marketing, advertising and clinical practice!

As Shakespeare’s Hamlet said, “Outcomes are the thing wherein we’ll catch the conscience of the king”. Perhaps Hans Christian Andersen stated it best when he concluded in his short tale, “Without revealing clinical outcomes, the Emperors of healthcare clearly have no clothes or value.”

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Howard Green, MD

Dermatologist & Mohs Surgeon, Inventor: Gamified Collective Intelligence Image Identification.

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