COMMENTARY

'The Providers': A 21st-Century Healthcare Fantasy

Michael V. Orlov, MD, PhD

Disclosures

September 16, 2019

I think to myself: Does this mean no one in particular is actually responsible? What happened to the old doctor-patient relationship, when the doctor was actually responsible? When the doctor went to the patient's home and was invited to big events as an honored guest, when the doctor would go to the weddings and funerals of his patients?

The POP states, "Well, nowadays this is actually prohibited. What if a provider eats something at the patient's home? This is called inducement!" My eyes roll: "What happens if the patient or family sues?"

Unfazed, the POP replies, "The MDP is still responsible and no one else. You see, the stupid malpractice companies still pay out much more if an MDP is to blame rather than any other provider. Also, the labor unions of provider nurses and secretaries have lobbied very hard not to extend malpractice coverage to their members."

The next stop on my tour is the telemedicine room. Multiple providers are sitting in front of computer screens and managing cases, similar to prior medical situations, but this time at remote locations. Microphones and earphones have replaced lab coats and stethoscopes. Many providers are manipulating some powerful robotic arms with joysticks while sipping coffee with their free hand.

"Do people ever die at those remote locations as a result of such operations?" I ask. "Oh yes, they do, but it doesn't matter," the POP replies "There is no PEMR on the other end, only robots, and they are not allowed to enter the data into the PEMR yet. Some providers are worried, however. There is uncertainty about job security as it is becoming easier and easier to substitute many functions of different providers by robots."

Only humans can 'find' mistakes even if there are none. Only humans can be nasty to other humans, whereas a robotic intellect is not capable of that yet.

"There were even violent demonstrations. Providers of all types were trying to prove to the government that they are better than robots. But don't worry, even if robotic providers do become a reality, someone will always need to report the data quality to HIPPA. There is no substitute for human providers as far as scrutinizing the work of others. Only humans can 'find' mistakes even if there are none. Only humans can be nasty to other humans, whereas a robotic intellect is not capable of that yet."

We go to the cafeteria, and the POP proudly shows me the back room where all the food is being prepared. Huge incinerators are in the anteroom, but their meaning will come to me only later in the tour. There is a striking resemblance to the operating theater we were just at: A similar conveyor belt drives plates with semi-prepared food between different stations manned by kitchen providers, or robots.

I notice a difference: As opposed to the operating theater, there's only one conveyor belt at the end. I ask the POP to comment on this. He responds enthusiastically, "All food is prepared excellently and equally; there is minimal waste, and there are no 'bad outcomes.' This is a perfect example of how one can computerize all steps of a fairly complex procedure and achieve good standardized results."

"How is the medical science nowadays?" I ask the POP. I am striving to find a glimmer of hope in this new Paradise of Providers. "It seems that at least the robotic procedures are very advanced. Are MPs able to extinguish old diseases, intervene at the level of human genome, and wipe out lethal viruses and cancers?"

"Yes, advancements have been made, but they were hampered by MPs collaborating with some industry hawks," grimly states the POP. "You see, working with these companies on development may potentially create huge conflicts of interest (COIs). As a result of these potential COIs, all further research has been banned. Any MP found guilty of industry collaboration or caught not having disclosed their old COIs by our wonderful PEMR is being discharged."

I am afraid to ask what "being discharged" means, but a sudden fear creeps into me as I begin to realize the meaning of those huge incinerators that we have encountered before entering the cafeteria. Is this the final realization of Soylent Green? Are collaborators and COI nondisclosers being used for food protoplasm in this medical home cafeteria?

We move on, and I begin to realize that this medical home is striving to become the epitome of medical efficiency in a gigantic provider network of the universe. It looks like it has achieved unparalleled results in many areas and is in line to improve further by wonderful MUC metrics. The only thing that seems to interfere with hospital and provider efficiency is the multitude of patients crowding the emergency department, clinics, and operating theaters. Patients do interfere with the hospital's efficiency! As we walk toward the entrance of the medical home, a huge manhole suddenly opens up underneath my feet.

I plummet into the abyss, and with that, I wake up. I am back in my study, surrounded by objects of my old and warm life as a physician.

Where was I? Was this an awful nightmare, or are we moving toward this new medical home at the speed of light?

This "Paradise of Providers"—where real medical care has been substituted by irrelevant computer metrics and inhumane goals, where the physician-patient relationship has simply disappeared, where so-called providers are only interested in the healthy status of the healthcare system and not of their patients, and where human life simply does not matter anymore—is becoming the new reality.

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