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Pyatt: Risk-based approach to health care frightening

Medicare and the health care producers are enforcing requirements mandated by the Centers for Disease Control and Prevention using a "risk-based" approach to provide the best family care as required by the Affordable Health Care Act. The basic concept is that certain core diseases — e.g., heart attacks, cancer and strokes — constitute a very high percentage of the health risk for seniors, as well as taxpayers money.

Although I started as an engineer and spent the first 20 years of my career in this field, I became an international expert in the use of health-risk assessment before retiring in 2008. I reported to the assistant secretary of energy for environmental safety and health, who was an MD/MPH from Johns Hopkins University. I became aware of collaborative efforts within the U.S. government and the medical community to implement risk-based methods and, in particular, the very strong biases and opinions within the medical community.

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Johns Hopkins Hospital, generally considered among the premiere hospitals in the world, and its medical school have always preached: "Fix everything." Don't be guided by risk analysis — Ptui! Treat the patient from all angles.

I have a pretty fair idea of what medical practitioners do and don't know, and the complications and side effects of the myriad pharmaceuticals used today is certainly not their strong point. Yet a required six-month "prescription review" is often the guise to perform medical lab tests that almost always lead to secondary problems. Physicians (and let's face it, they rule the roost) are unprepared by training and temperament to deal with risk approaches and appropriate data uses, nor do they have the time and tenacity to follow up. My own knowledge is seven years dated, and that is a lifetime in this fast-growing field.

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Initially, most doctors over the age 45 or 50 and their patients will resist (rightly, I think) the new "Medicare Mandated" system — or at least how most health care providers are misapplying them — and both will probably bubble through the process to some extent, with older doctors eventually becoming frustrated and retiring. Older patients will suffer more and more as we have to work with younger doctors.

Family care practitioners are becoming highly paid data entry typists and generally will be frustrated that they are stuck in a reasonably well-paid — but certainly not what they expected when they started their careers — rut, and there will be minimal doctor-patient interface. Eventually there will be almost none. There will be unnecessary churning of visits and lots and lots of lab results (with red flags all over the place), which eventually will trivialize the intent of this system.

Unless one maintains and keeps a good electronic filing system — which is for all practical purposes what I have done for some time now — doctors and patients will be lost in a sea of blurred data not meeting the initial intent of the guidelines.

My family doctor, when I ask too many questions, says, "You have 15 minutes, and the clock is ticking," adding it would be best for me to listen and not talk. The doctors — and this is the fatal flaw — are supposed to have a patient-dialogue discussion. They're either typing or giving orders. No listening is involved.

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How did this system happen? More importantly, what can be done about it?

I think I offered some opinions on the first part. The second question is the more difficult, and important, one to address.

I know it goes against the grain — and I don't particularly like confrontations — but one must consider each doctor's visit a cold-blooded business negotiation but with both your life and the future of Medicare at stake. Keeping Medicare solvent is how this all began in 2011. You must be just as informed and tenacious as medical professionals are. This is actually not as difficult as it seems since medical laboratory tests (the cornerstone of modern family practice) are now provided, and there is a wealth of generally recommended guidelines and procedures for what to do next.

I'm extremely grateful that young men and women still want to pursue a medical career at a cost of typically 15 hard years of their life and a cost of somewhere around a million dollars average in debt burden. I also believe in the American Dream. I also realize doctors are incredibly bright and generally well-informed in their fields. I'm also grateful that my overall health remains pretty good. But I'm afraid good personal health in the future may lie more in "spite of them" rather than "because of them." It's more than a little scary.

Dave Pyatt writes from Mount Airy.

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