The background story provided for the Max Headroom character in his original appearance comes from a dystopian near-future dominated by television and large corporations. The AI of Max Headroom was shown to have been created from the memories of crusading journalist Edison Carter. The character's name came from the last thing Carter saw during a vehicular accident that put him into a coma: a traffic warning sign marked "MAX. HEADROOM: 2.3 M" (an overhead clearance of 2.3 meters) suspended across a car park entrance.
Last night I attended Journal Club at the Portsmouth Regional Hospital, where doctors assemble after hours to discuss the month's New England Journal of Medicine articles, an effort to keep up to date.
As usual, before we got down to the articles, there was a little banter and gossip and the big news was that the virtual neurologist had gone on the fritz and the neurologist at the table was roped into seeing a stroke victim in the Emergency Department.
Turns out this was all just a small window into a much bigger story: Apparently, the Hospital Corporation of America (HCA) has concluded that its efforts to support office practices of neurologists, pulmonologists, cardiologists, primary care is a losing proposition, financially. These practices have always been what hospitals depend on to "feed" the hospital patients, who need the MRI's., emergency care, laboratory studies, hospital beds, ICU beds, maternity beds. But the practices often just barely break even and, the speculation is, HCA realized they can do away with all that burden and simply try to profit from the hospital.
They got the hospital declared a Level Three (or some level) "trauma center," to focus on where the money is.
But, to do this, you need to create a "Stroke Center" which means that any patient who comes to the Emergency Department with a stroke has to be seen within an hour and evaluated by a neurologist to see if he needs a "clot busting" drug run into his carotid arteries to break up a clot which is preventing brain tissue downstream from getting oxygen carrying blood.
The problem is, if the stroke victim has a Hemorrhagic stroke, one cause not by clot obstructing blood flow but by bleeding into the substance of the brain, giving a "clot buster" makes the blood flood a large part of the brain, making the stroke much worse.
So a neurologist has to see the patient.
The problem is, HCA fired most of its neurologists so how do you get the neurologist to the bedside in the emergency department?
Enter the mobile monitor/computer on a rolling cart and the neurologist appears courtesy of a Skype like technology. He may be in Nebraska, and he "interviews" the patient, while a nurse does the physical exam.
Now, of all physical exams, the neurological physical exam is among the most difficult and requires the most experience and touch, but, never fear, a nurse can be trained up, apparently.
At this point, my mouth is agape and I know I'm being played. I started laughing.
"Oh, for a moment there, you had me going! I thought you were serious."
Actually, they were serious. There is such a thing.
And that day the system went down on the "Stroke Center."
That got me thinking about what can and cannot be done off site.
For nearly a decade CT and MRI scans have been done in American emergency rooms and read by a doctor sitting at a computer in India. That horrifies American patients but doctors have long ago accepted this. After all, American radiologists, seeking an easier life, demanded the images be sent to their homes so they didn't have to get out of bed to drive over to the hospital and it's all on computer, so why not?
In a sense, American doctors have brought this concept and its consequences on themselves.
But neurologists were among the last bastion of real live clinicians, that neurological exam being an art and a hands on thing. Like plumbers and electricians, you can't just do it virtually from afar. Until now.
I guess surgeons are safe, for now at least. We haven't go to the point where you are wheeled into the operating room, lifted off the gurney and placed on the operating table by a robot and have your appendix removed by a robot.
But just you wait.
It's all so much more efficient and profitable.
Who wants to be the Luddite in medical care?
We have reached the point of the Max Headroom physician. He is not an actual human being at the bedside. He exists only on the monitor screen.
That's your Trauma Center and Stroke Center you drove past your local community hospital to reach.
Welcome to for profit medicine, America. It's all yours now.
Last night I attended Journal Club at the Portsmouth Regional Hospital, where doctors assemble after hours to discuss the month's New England Journal of Medicine articles, an effort to keep up to date.
As usual, before we got down to the articles, there was a little banter and gossip and the big news was that the virtual neurologist had gone on the fritz and the neurologist at the table was roped into seeing a stroke victim in the Emergency Department.
Turns out this was all just a small window into a much bigger story: Apparently, the Hospital Corporation of America (HCA) has concluded that its efforts to support office practices of neurologists, pulmonologists, cardiologists, primary care is a losing proposition, financially. These practices have always been what hospitals depend on to "feed" the hospital patients, who need the MRI's., emergency care, laboratory studies, hospital beds, ICU beds, maternity beds. But the practices often just barely break even and, the speculation is, HCA realized they can do away with all that burden and simply try to profit from the hospital.
They got the hospital declared a Level Three (or some level) "trauma center," to focus on where the money is.
But, to do this, you need to create a "Stroke Center" which means that any patient who comes to the Emergency Department with a stroke has to be seen within an hour and evaluated by a neurologist to see if he needs a "clot busting" drug run into his carotid arteries to break up a clot which is preventing brain tissue downstream from getting oxygen carrying blood.
The problem is, if the stroke victim has a Hemorrhagic stroke, one cause not by clot obstructing blood flow but by bleeding into the substance of the brain, giving a "clot buster" makes the blood flood a large part of the brain, making the stroke much worse.
So a neurologist has to see the patient.
The problem is, HCA fired most of its neurologists so how do you get the neurologist to the bedside in the emergency department?
Enter the mobile monitor/computer on a rolling cart and the neurologist appears courtesy of a Skype like technology. He may be in Nebraska, and he "interviews" the patient, while a nurse does the physical exam.
Now, of all physical exams, the neurological physical exam is among the most difficult and requires the most experience and touch, but, never fear, a nurse can be trained up, apparently.
At this point, my mouth is agape and I know I'm being played. I started laughing.
"Oh, for a moment there, you had me going! I thought you were serious."
Actually, they were serious. There is such a thing.
And that day the system went down on the "Stroke Center."
That got me thinking about what can and cannot be done off site.
For nearly a decade CT and MRI scans have been done in American emergency rooms and read by a doctor sitting at a computer in India. That horrifies American patients but doctors have long ago accepted this. After all, American radiologists, seeking an easier life, demanded the images be sent to their homes so they didn't have to get out of bed to drive over to the hospital and it's all on computer, so why not?
In a sense, American doctors have brought this concept and its consequences on themselves.
But neurologists were among the last bastion of real live clinicians, that neurological exam being an art and a hands on thing. Like plumbers and electricians, you can't just do it virtually from afar. Until now.
I guess surgeons are safe, for now at least. We haven't go to the point where you are wheeled into the operating room, lifted off the gurney and placed on the operating table by a robot and have your appendix removed by a robot.
But just you wait.
It's all so much more efficient and profitable.
Who wants to be the Luddite in medical care?
We have reached the point of the Max Headroom physician. He is not an actual human being at the bedside. He exists only on the monitor screen.
That's your Trauma Center and Stroke Center you drove past your local community hospital to reach.
Welcome to for profit medicine, America. It's all yours now.
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