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Chuck vs the hospital

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If you’ve been in Israel more than 10 minutes you know that, by law, one major sector must always be on strike.  Shockingly, this time it’s not going to be the garbage men, the dock workers, or the government clerks (although you never know).  The next group set to strike is the doctors.

While the main argument is over money (bet you didn’t see that one coming), the doctors also want extra incentives for doctors to work in fields where there is a lack, namely, anesthesiology and pre-natal care.  This seems logical; after all, a rise in salary would entice more doctors to enter into this field and would help the shortage in the hospitals.

Unfortunately, economically speaking, this plan is not viable in the short term.  Incentives could only entice doctors who are only entering medical school.  The prospective doctors would not actually be working in the field for several years.  (I do not count doctors that leave for work abroad because I do not believe a marginal increase in pay would sway an anesthesiologist from the much higher salary he would still make abroad.)  Logically, the government should only guarantee these extra incentives in 6 or 7 years, when the current perspective doctors will actually enter the field.

But another, more important option is not being mentioned in this debate.  That option is to deal with the shortage via a computer system that would unite the current systems in the Kuppat Cholim and at the Hospitals.  You see, while the computer system at your Kuppat Cholim is fantastic, and the one in the Hospitals is decent, there is no interaction between them.  As a result, doctors waste much of their time piecing together information.  I can tell you first hand that the overwhelming majority of time I have spent with my wife and the pre-natal physician was spent piecing information together.

And it’s such a shame.  A few weeks ago, we spent literally 4 hours waiting for a couple of physicians to go through approximately 10 women in order to meet with us.  And even then, the doctor was pushy and anxious to get to the next patient, so we did not receive her full attention.  She spent most of her time asking my wife to find various papers and tests results and then did an ultrasound and gave a quick diagnosis.

If Israel were to have a national computer system that could combine medical files and speak to the different electronic systems, then the amount of time a pre-natal doctor spends with a patient could easily be halved.  The shortage could be dealt with instantly, patients would be able to feel the results and misdiagnoses would drop.  Of course this could not work with anesthesiologists or surgeons, but for doctors whose primary role is diagnostics, a new computer system would be the most effective way to improve Israel’s medical system.

So while the doctors stand on one side of the picket line and the government puts up a fight that we know will end in 3 weeks with them caving in, you and I should be rooting for a new computer system that will be a cross between Chuck and House.

Have you been in an Israeli Hospital?  What do you think would improve the system?

PS – Have you ever noticed that people who strike in Israel don’t even go to a picket line?  How lazy is that!?


6 Comments

  1. Genius says:

    More centralization is your idea of how to fix this problem? Uniting all the medical information about each of us and putting it at the fingertips of bureaucrats who’ll get their jobs through political patronage?

    How about just letting doctors’ salaries reflect their actual value according to the market?

    • jonnydegani says:

      Interestingly, the demands of the doctors advocates a more free market type of system – those doctors with the greatest need (least supply, most demand), would get most. I only disagree because (1) I would like to see something happen in th short run (2) we are a high tech country and it is pathetic that we can’t have effective medical data and (3) I think that political patronage will turn what should be incentives for supply and demand into a system that will build a medical bubble as bad as it is in the United States.
      I am just curious, why are you opposed to a medical system that would make it easier to be diagnosed correctly? With all the downsides that come will a centralized government, we should at least get the one upside of centralized medical data.

  2. Genius says:

    I am just curious, why are you opposed to a medical system that would make it easier to be diagnosed correctly? With all the downsides that come will a centralized government, we should at least get the one upside of centralized medical data.

    I’m a heavy user of the medical system (lots of medical problems, some long undiagnosed) so this is an issue I can understand both in theory and in practice. I am willing to let computers do a lot of things, but it’s a fact that computers are terrible at making medical diagnoses.

    There’s a very good reason why doctors go to medical school and learn how to take a patient’s medical history, learn how to observe a patient, ask questions, discuss symptoms, explain what symptoms mean, listen carefully, ask questions again, follow up and finally make a diagnosis. Computers simply can’t do this. Nor can doctors who rely on centralized information already in a computer system. There is NO substitute for a human doctor who knows how to think and who chooses to think.

    Centralized consumer information (and don’t forget, a medical patient is a consumer of medical care) is never put to use altruistically for consumer benefit. Imagine if there was a database of all the groceries your family bought. Do you think it would be used to figure out the kind of challot your kids like and make them cheaper? No, of course not – it would be used to do things like making 10 hot dogs to a pack and eight buns to a pack, to be certain that the Degani family would pay for six more buns than they needed.

    That’s not to say that this information can’t benefit consumers. I wish sometimes that someone would observe how whenever Mountain Dew, Life cereal, cayenne powder and Kerry butter (from Ireland) appear in my neighborhood, they’re always bought out immediately, and use this information to profit by importing those products more regularly.

    I think that political patronage will turn what should be incentives for supply and demand into a system that will build a medical bubble as bad as it is in the United States.

    That’s the difference between “market” and “market-like” systems. In a market system, producers (in this case, doctors) are rewarded based on what they’re worth according to the market. In a market-like system, planners calculate what they think a market would reward, and then they reward that amount (minus their share, of course). I don’t see any particular need for planners to be involved at any level in determining what doctors should earn.

    • jonnydegani says:

      Perhaps I was not clear. I don’t want computers to diagnose; I want them to put all the relevant information at the click of a button, so that the doctor can diagnose. (Have you ever used Web MD? – “your runny nose may be caused by the common cold or syphilis”).
      Instead of going through papers for blood tests, some in the hospital and some at kuppat cholim, it should all appear together by just entering my TZ into the system.
      As part of the birthing course I am going through with my wife, I was advised to have certain papers in a certain order for the particular hospital where my wife is giving birth or else the doctors may not know something important and may mess up. How crazy is that?! Shouldn’t all the correct medical tests be available by just saying our name and TZ #? How can they rely on the patients providing such information, especially at such an emotional time. What if we are caught off guard and don’t have our entire medical file with us?! This is what computers are made for!

      About your last point – It is very difficult to have a free-market system for doctors when the system runs through insurance. It isn’t like the market for ice cream where you pay when it’s the right price and don’t when it isn’t. This is a system where a government is trying to, on behalf of the people and their taxes, remove some risk from their lives by providing insurance. And once you are using (1) a government and (2) a risk barrier, the many modifications in behavior make it difficult to turn out a purely free market system.

  3. LeahGG says:

    2 things – 1, your bloodwork, major tests, list of recently prescribed medications, and allergies should be available system-wide. Other things probably should be taken by each doctor. The main issue with this is most likely patient privacy which is no small matter.

    2. incentives would not apply only to new medical students. Doctors choose their fields AFTER their internship before their residency, meaning 2-4 years before entering the hospitals/clinics.

    Plenty of medical students change their minds regarding specialties as late as their internship, particularly if a good residency option suddenly becomes available.

    • jonnydegani says:

      1 – Why is there a fear of privacy? If I can’t hide my medical info from my kuppat cholim, why should I have it hidden from a hospital?
      2 – “incentives would not apply only to new medical students. Doctors choose their fields AFTER their internship before their residency, meaning 2-4 years before entering the hospitals/clinics.”
      Leah,
      You are 100% correct. I guess that as a Kohen, I never looked into the statistics of med school very thoroughly. Thanks for the correction.

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