The e-Patients Group has been discussing Shannon Brownlee’s book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, which tells how the logic of the U.S. healthcare system works against coordination and effective treatment. “Between 20 and 30 cents on every health care dollar we spend goes towards useless treatments and hospitalizations, towards CT scans we don’t need, towards ineffective surgeries—towards care that not only does nothing to improve our health, but that we wouldn’t want if we understood how dangerous it can be.”

One crucial issue we’ve been discussing is the lack of coordination among healthcare providers and resulting treatments based on fragmented understanding of the patient’s whole profile.

Suffice it to say, the e-Patients Group is not of one mind on this subject, due in large part to the different set of major challenges faced by the doctors and patients among us, both fighting for their breath in this dysfunctional system. Below are some excerpts from our respectful but strong-willed expressions of views.

In an article in the April 2008 issue of More magazine, Brownlee cites Johns Hopkins professor W. Lowell Maughan saying “Many hospitals today …. are like medical shopping malls”; she continues “When you go to the mall, the clerk in one store has no idea what you bought next door, and the same often holds true for the departments in a hospital.”

Dan Hoch notes the issues of communication and logistics that healthcare professionals must confront.

…imagine if you were in sales, and you called on 50 clients a day. Now, imagine you had to call 3 people after each of those visits to coordinate the sale you were trying to make, but worse, each of those people was out doing the same thing you were doing and did not pick up the phone. So, you leave messages, do some emails, and hope for the best. Of course, just as those folks get back to you, you start a new day. There is no way our traditional system can support this level of interactivity. That’s why we need electronic medical records. BUT, even at that, patients ask me regularly and incredulously “you mean you didn’t talk to my other doctors? “. I’m going to go out on a limb here and say verbal one on one communication is not possible and should not be an expectation. Humans don’t cut it. Machines do a better job just as they do a better job at keeping vast bits of data in memory.

e-Patient Dave acknowledges the logistical hurdles but isn’t swayed by them. It was inexcusable, he says, for nephrectomy nursing staff involved in his treatment to have no idea that he had a major leg problem (a femur metastasis that eventually caused the leg to break) – “there MUST be SOME way that when a new staff person comes on team, they get an introduction to the whole me, not just their ‘store in the mall.'” There’s no mechanism, responsibility, or funding for coordination of care and this, says Dave, “is a huge and unacceptable breakdown in the system.”

In today’s process (in America anyway) nobody’s got responsibility, and adding [Electronic Medical Records] to a broken process won’t change that. As we say in my day job: “Process first, then define the system.”

One possible solution: the Patient-Centered “Medical Home,” where each patient is known and understood as a whole person, and where there’s coordination through a complete health profile, reducing or eliminating the possibility of incorrect or “over-” treatment.

What are some other possible solutions? We invite your comments.

Additional content and editorializing by e-Patient Dave