Post-apocalyptic life in American health care | Meaningness


23 bookmarks. First posted by wycx 6 weeks ago.


TL;DR:

Much of my time for the past year has been spent navigating the medical maze on behalf of my mother, who has dementia.
I observe that American health care organizations can no longer operate systematically, so participants are forced to act in the communal mode, as if in the pre-modern world.
Health care is one leading edge of a general breakdown in systematicity—while, at the same time, employing sophisticated systematic technologies.
Communal-mode interpersonal skills may become increasingly important to life success—not less, as techies hope.
For complex health care problems, I recommend hiring a consultant to provide administrative (not medical!) guidance.

Epistemic status: impressionistic blogging during a dazed lull between an oncologist and an MRI. No attempt to validate with statistical data or knowledgeable sources.
health  systems  society  usa  government 
9 days ago by micktwomey
My god, this is so dysfunctional.

'I observe that American health care organizations can no longer operate systematically, so participants are forced to act in the communal mode, as if in the pre-modern world.
Health care is one leading edge of a general breakdown in systematicity — while, at the same time, employing sophisticated systematic technologies.
For complex health care problems, I recommend hiring a consultant to provide administrative (not medical!) guidance.'

via Craig.
bureaucracy  healthcare  health  systems  us-politics  insurance  medicine  dysfunctional  fail  fiasco  via:craig 
12 days ago by jm
Experiences navigating disintegrating American health care institutions, and what they might imply for life in 2037
healthcare 
19 days ago by geetarista
I suspect increasing “patchiness” of systems may be typical of our post-systematic atomized era. Understanding the medical case may help predict the texture of cultural and social life as atomization proceeds.

A central research topic in ethnomethodology is the relationship between formal rationality (such as an insurance company’s 1600 pages of unworkable rules) and “mere reasonableness,” which is what people mostly use to get a job done. The disjunction between electronic patient records and calling around town to try to find out who wrote a biopsy report that arrived by fax seems sufficiently extreme that it may produce a qualitatively new way of being.
healthcare 
19 days ago by ptsteadman
Perhaps American health care is a bellwether model for the future of other aspects of life in the post-systemic world? A pattern that occurs in many other sectors: as systems fail, people fall back on innate communal logic. Politics and the media are obvious current examples.
19 days ago by tinotopia
"TL;DR:

• Much of my time for the past year has been spent navigating the medical maze on behalf of my mother, who has dementia.

• I observe that American health care organizations can no longer operate systematically, so participants are forced to act in the communal mode, as if in the pre-modern world.

• Health care is one leading edge of a general breakdown in systematicity—while, at the same time, employing sophisticated systematic technologies.

• Communal-mode interpersonal skills may become increasingly important to life success—not less, as techies hope.

• For complex health care problems, I recommend hiring a consultant to provide administrative (not medical!) guidance.

Epistemic status: impressionistic blogging during a dazed lull between an oncologist and an MRI. No attempt to validate with statistical data or knowledgeable sources."



"It’s like one those post-apocalyptic science fiction novels whose characters hunt wild boars with spears in the ruins of a modern city. Surrounded by machines no one understands any longer, they have reverted to primitive technology.

Except it’s in reverse. Hospitals can still operate modern material technologies (like an MRI) just fine. It’s social technologies that have broken down and reverted to a medieval level.

Systematic social relationships involve formally-defined roles and responsibilities. That is, “professionalism.” But across medical organizations, there are none. Who do you call at Anthem to find out if they’ll cover an out-of-state SNF stay? No one knows.

What do you do when systematicity breaks down? You revert to what I’ve described as the “communal mode” or “choiceless mode.” That is, “pre-modern,” or “traditional” ways of being.

Working in a medical office is like living in a pre-modern town. It’s all about knowing someone who knows someone who knows someone who can get something done. Several times, I’ve taken my mother to a doctor who said something like: “She needs lymphedema treatment, and the only lymphedema clinic around here is booked months in advance, but I know someone there, and I think I can get her in next week.” Or, “The pathology report on this biopsy is only one sentence, and it’s unsigned. The hospital that faxed it to me doesn’t know who did it. I need details, so I called all the pathologists I know, and none of them admit to writing it, so we are going to need to do a new biopsy.”

But at the same time, each clinic does have an electronic patient records management system, which does work some of the time. And there are professional relationships with defined roles that operate effectively within the building.

I suspect increasing “patchiness” of systems may be typical of our post-systematic atomized era. Understanding the medical case may help predict the texture of cultural and social life as atomization proceeds.

A central research topic in ethnomethodology is the relationship between formal rationality (such as an insurance company’s 1600 pages of unworkable rules) and “mere reasonableness,” which is what people mostly use to get a job done. The disjunction between electronic patient records and calling around town to try to find out who wrote a biopsy report that arrived by fax seems sufficiently extreme that it may produce a qualitatively new way of being.

I would like to ask:

• How does health care continue to function at all?

• Can it continue to function at all?

• How do people within the ex-system navigate a world that mashes up high-tech infrastructure that only sometimes works with pre-modern social relationships across organizations?

• How do they understand this contrast? How do they cope personally?1

• What can we do about it?"



"Perhaps American health care is a bellwether model for the future of other aspects of life in post-systemic world? A pattern that occurs in many other sectors: as systems fail, people fall back on innate communal logic. Politics and the media are obvious current examples."
us  healthcare  systems  2017  medicine  davidchapman  medicalcostdisease  costdisease  economics  bureaucracy  communication  politics  absurdity  media 
21 days ago by robertogreco
> Standardizing an interface between health care providers and insurance companies would be a huge win. No matter how badly designed, it would be better than the current mess, and save several percent of US GDP. That would need cooperation from most of the major players in the industry. Other industries manage that routinely: machine screws and futures contracts come in standard sizes, without which manufacturing and finance would be as inefficient as health care. The need for a standard insurer/provider interface is obvious. Since it’s lacking, I imagine some powerful group extracts enormous rents from the inefficiency. I know nothing about that, so I won’t speculate.
healthcare  US  2017  bureaucracy 
5 weeks ago by porejide
"My job for ten years has been understanding how to get insurance to pay us. I have no idea how the system works."
from twitter
5 weeks ago by TaylorPearson
While American healthcare technology advances into the mid-21st century, American healthcare bureaucracy regresses towards the medieval. “Hospitals can still operate modern material technologies (like an MRI) just fine. It’s social technologies that have broken down and reverted to a medieval level. Working in a medical office is like living in a pre-modern town. It’s all about knowing someone who knows someone who knows someone who can get something done”
from instapaper
5 weeks ago by petulantskeptic
TL;DR: Much of my time for the past year has been spent navigating the medical maze on behalf of my mother, who has dementia. I observe that American health…
from instapaper
5 weeks ago by rogerhsueh