I'm not sure that's relevant to the article - it sounds like a general lament about the US healthcare system that could have been attached to any article on US healthcare. Have we established that doctors in the US have to deal with more documentation than doctors in other industrialized healthcare systems? I think establishing that is required to turn this discussion into one about the problems of the US healthcare system versus others.

Regarding the content, this doctor provides compelling arguments that the documentation doctors have to require takes a large toll on the doctors themselves and their patients, but I'm curious if we can look at data to corroborate that. For example, maybe the copious note taking improves patient care because more information is available to more people, and is not trapped in the head of one doctor. Note I am not saying that is necessarily true, but we've been presented with arguments and anecdotes - very compelling ones, which I am inclined to agree with. But it is probably not wise to change healthcare policy without looking at what data we can.

> Have we established that doctors in the US have to deal with more documentation than doctors in other industrialized healthcare systems?

Yes. The authors cite data showing that physicians in Canada spend far less time on administration than do U.S. doctors, http://www.eurekalert.org/pub_releases/2014-10/pfan-pco10231... Administrative work consumes one-sixth of U.S. physicians' working hours Note, this is non patient related Administrative work.

Now what? IMO, the simplest solution is for doctors to bill based on administrative requirements.

Yes, very interesting. But it is non-patient administrative work, so I'm not sure if it applies to the submitted article. That does, however, support the argument that in general, the US system requires more administrative work, yet (I believe), the US and Canadian systems achieve about the same health outcomes. And I also believe the Canadian system is cheaper. It's then reasonable to conclude that the many layers of the US healthcare system are the cause.

It would be reasonable for patient-related notes to be correlated with other administrative work, but it's not necessarily so.

The article points out that most of these notes are not related to patent care.

A seasoned supervisor told me that, when he was a resident working in the psychiatric emergency room, he used to see more than three times as many patients as we residents see now.

“How?” I asked him, with an incredulous lilt in my voice that could barely be masked.

“Our notes could be shorter back then,” was his reply. (Insurance, regulations and electronic health records weren’t issues back then.)

Correct, and I understood that, so I was not clear. My question was on whether or not patient notes are also associated with more-bureaucracy-for-the-same-health-outcome. At higher cost. Maybe more patient notes actually lead to better health outcomes, even though they're an annoyance for doctors and cause them to see less patients.

Got it, it's a good point and worth looking at. Doctors taking lot's of notes while in with a patent could also lead to worse outcomes as they are distracted.

However, ~50% increase in healthcare costs would need to have a huge impact on patent outcomes or drastic fraud reduction to be worth it.

I'm honestly surprised just how much red tape there must be in the US health care system. Even fully socialized systems managed by the civil service get away with less bureaucracy over here in Europe, which is just insane (and the complete opposite of virtually everything else). And the US system is not even significantly more effective for it (if at all), despite being 50-100% more expensive per patient.

How did it end up becoming this broken in the first place?

I think this is a good example where the usual association government run = bureaucratic ; privately run = straightforward breaks down because bureaucracy/non bureaucracy is not a function of the economic model but that of the inherent simplicity of the model. One of the reasons why many soicialised systems of healthcare are 'simpler' is because they have universal coverage which means that the whole process of checking who is eligible to see a doctor, does their plan cover this doctor, did they pay their premium, which treatments they are eligible for, how much of their spending limit they have exhausted do not exist because everyone is eligible and everyone is eligible for everything. It is like going to an all you can eat buffet and wondering why is no one writing down what I am eating :-). I could add more examples to it e.g. If all surgeons are paid a fixed salary there need not exist an infrastructure to count how many stitches they applied this quarter and so on..

Yet, we do track most of these metrics. Doctors are paid on work done and don't have fixed salaries, GPs have overly complicated spending limits on various resources, and so on. Checking patient eligibility alone can't explain an additional $5000 cost per patient and year.

You may have misunderstood. I was not trying to explain the $5000 gap. Administrative costs is one example of the cost difference. Research shows that 'socialised' health systms spend up to $ 800-900 less per patient per year on admin. (I think it was diff between USA and Canada) I am not sure of other systems but in NHS England there is no tracking of actual number of patients seen in primary care and details of each patient's complaint. The last audit done on that was over 5 years ago which was also based on data sampling and no such audit is currently planned. There are other reasons for high cost - one of the is the list pricing of actual products used (socialised systems pay less for products, UK pays about 20% less for pharmaceutical products than many other industrial nations). UK consultants and surgeons are not paid for how many procedures they do, 'coincidentally' UK surgeons operate less frequently. I am sure there are several other reasons that explain the $5000 gap but these are just a few.

This doesn't answer your question but .. If you look a little closer you'll see that there is a lot changing in the medical system. 1. More and more computer use in every aspect. 2. Huge companies are being formed through the merging or buyout of hospitals and large provider networks. 3. The way insurances pay doctors is changing and these insurance companies (which are flat out buying up doctors offices, for example United Healthcare, Optum and all that their doing) have huge control over the price of health care.

You might be right that there is a breaking point, but there is a ton changing right now so I don't see that point any time soon.

I'm not sure the Huge companies forming is a good thing. If we need more competitive pricing, having only 1 or 2 health care systems in a given locale could be seen as a local monopoly.

I know the bigger systems get more negotiating power so in the short term this should probably help but if the local competition isn't there than that money just stays in the hospital pockets.

Yeah, that's a valid concern for sure. I'm very worried about how much insurance companies make and how much control they have over prices. Seems like a conflict of interest to be the insurance company and the boss of the person you are paying through that insurance.

In order to change something, you usually have to break it first.