To look at the guitar the book the computer the dreams the hopes the wants and desires and knowing that they won't come true well that really sucks but we can make sure that while we're still sentient that bring us comfort and happiness like friendship or music or visits

The USA has a big problem it's called healthcare and it is failing us terribly in quality of life. It is humiliating us if quantity is not affordable or available. This is not a problem of quantity but quality how can we know what makes quality in a life if we don't speak it?

…ironically, letting the two hospitals continue but requiring them to not duplicate services might mean, for instance, that you’d have to chop a pt up if the pt’s issues bridged the artificial admin divide, or invent a workaround, or probably, a waiver. Clerical….

And again this is out of sequence, sorry. But fast-forward to the 80s and the ‘non-duplication’ had begun to spawn whole different types of facilities, and subsets of regulations. CMS ‘surveyors’ of reg compliance rapidly turned over (private healthcare/insurance pays more).

The results were several. One was occasional goofs. Some surveyed facilities ran on a shoestring &/or had poor data connectivity & limited # of computers/computer savvy people onsite. So surveyors took notebooks, worked by hand on paper. Sometimes they took wrong notebook…oops

Then they would enter the results of the survey back at the office…when they could get access to the system. At which point, anecdotally, they found a mismatch between type of survey they’d done and criteria they should have applied. Oops. Hope my contractor work for CMS helped.

Health care insurance entities and plans proliferated. (=More clerical burden for docs.) They were forced to cope, and had to hire clerical workers not just to bill, but to ‘code’ for billing. Have a look: could you keep up? It’s ICD-10/9 as of 2021…cms.gov/Medicare/Coding/ICD1…

Meanwhile, research had advanced and NIH tried to put it online, but it was hard to use. When I went back for my dad’s funeral in 1989, a UPenn-educated obstetrician asked if I had any influence in the interface that would make it usable…

Now we have the Web, and Google Scholar, and NCBI and others for doctors, some info behind pay walls after med school. A few big hospitals have put up medical information aimed at helping consumers, but at the bottom somewhere is the business pitch: “ To make an appointment…”

With the proliferation of information, *IF* a pt has access to online information, Topol notes a new challenge for doctors: the info available may mislead non-doctors. That can confuse taking a history and making a diagnosis.