Health care moving away from actual human care?

A really interesting article in the NYT about how the focus of the medical system is trending towards "checking off the boxes" (i.e. quality indicators, EHRs, etc.) which is indeed contributing to a higher quality of care, but at the same time providing less patient care since doctors pay less attention to patients.

Here's an exerpt:

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from Checking the right boxes, but failing the patient, By DENA RIFKIN, M.D.
http://www.nytimes.com/2009/11/17/health/17case.html?_r=1

"None of these interventions, however well meant, address a fundamental problem that is emerging in modern medicine: a change in focus from treating the patient toward satisfying the system. The effects of focusing physicians’ attention on benchmarks and check boxes are not, I think, to the patient’s advantage.

A close family member was recently hospitalized after nearly collapsing at home. He was promptly checked in, and an electrocardiogram was done within 15 minutes. He was given a bar-coded armband, his pain level was assessed, blood was drawn, X-rays and stress tests were performed, and he was discharged 24 hours later with a revised medication list after being offered a pneumonia vaccine and an opportunity to fill out a living will.

The only problem was an utter lack of human attention. An emergency room physician admitted him to a hospital service that rapidly evaluates patients for potential heart attacks. No one noted the blood tests that suggested severe dehydration or took enough history to figure out why he might be fatigued.

A doctor was present for a few minutes at the beginning of his stay, and fewer the next day. Even my presence, as a family member and physician, did not change the cursory attitude of the doctors and nurses we met.

Yet his hospitalization met all the current standards for quality care.

As a profession, we are paying attention to the details of medical errors — to ambiguous chart abbreviations, to vaccination practices and hand-washing and many other important, or at least quantifiable, matters.

But as we bustle from one well-documented chart to the next, no one is counting whether we are still paying attention to the human beings. No one is counting whether we admit that the best source of information, the best protection from medical error, the best opportunity to make a difference — that all of these things have been here all along.

The answers are with the patients, and we must remember the unquantifiable value of asking the right questions."

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I find it difficult not to completely agree with Dr. Rifkin. To me, being in a hospital is scary enough because you're feeling icky. Add to that the fact that doctors are completely impersonal (I haven't seen the same doctor since I was 11)... I and many others have good incentives to stay away from seeking health care. Even preventative care - sure it's good for you, but it seems like such an ordeal.

Medical homes would be a good way to address this issue - Healthy San Francisco seems to be doing a good job at this. HSF provides low cost medical care to low income residents of SF; they've been getting patient satisfaction reviews that have been incredibly good.

Fundamentally though, for real change to occur, I think that the amount of time spent with patient should be a clinical quality indicator. And, perhaps doctors should also be required to undergo multidisciplinary training. Medicine is never purely about science - the biggest reason we bother to take care of our physical health is because it affects our emotional well being. Hmm...maybe M.Ds should be required to take psych classes instead...?