Unintended consequences of health policies – heeding HL Mencken and Gary Klein

Unintended consequences of health policies can have dramatic negative impacts.  HL Mencken wrote 98 years ago,  “Explanations exist; they have existed for all time; there is always a well-known solution to every human problem—neat, plausible, and wrong.” (https://quoteinvestigator.com/2016/07/17/solution/)  When policy wonks and legislators and rule makers seek to solve problems in medicine they seemingly forget this admonition. Here are 3 examples of poorly considered solutions: Electronic health records – in the abstract this seems like an obvious idea.  But the problem they address is very complex and we had to adopt them before they were really ready to make practice go smoother.  We can all name the unintended consequences of EHRs.  If you want to better understand the prematurity of their forced adoption please ready Bob Wachter’s excellent account – The Digital Doctor The 4 hour rule for community acquired pneumonia.   This well meaning rule from CMS started the trend towards overuse of antibiotics for patients who do not have pneumonia.  The influences of this rescinded rule persist today.  Some estimate that 25-30% of admissions for CAP actually have a different diagnosis. Myriad rules restricting physician prescribed opioids.  My colleague Stephan Kertesz (and his national associates) have written extensively on this topic.  Here is one example article – Opioid Prescription Control: When The Corrective Goes Too Far ...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs