The frog in the boiling water and health care

Neil Baum, MD

You might have heard that if you drop a frog in a pot of boiling water, it will jump out right away, but if you put the frog in lukewarm water and slowly heat it up, the frog won't survive. The frog's big problem is that it cannot rethink the situation. It doesn't realize that the warm bath is becoming a death trap -- until it's too late.

Doctors might be smarter than frogs, but our world has slow-boiling pots. Think about how slow people were to react to warnings about a pandemic, climate change, or a democracy in peril.

We fail to recognize the danger because we're reluctant to rethink the situation or the heat increases so slowly that we fail to recognize the danger ahead. We struggle with rethinking in all kinds of situations. We expect our squeaky brakes to keep working until they finally fail.

Heat from the EMR\insurance companies

The system has imposed many administrative activities that distract from patient care and burden doctors with more time inputting data than focusing on patients. A common example is the electronic medical record. Physicians must complete their records, which often includes "pajama time" or working in the evening for several hours without being compensated for their time. This translates to slowly turning up the heat like the frog in hot water.

Heat from artificial intelligence (AI)

The heat is coming from artificial intelligence (AI), which is slowly being integrated into medical practices to improve diagnostics, streamline administrative tasks, and personalize treatment plans. This includes AI-driven imaging analysis, predictive analytics, and virtual health assistants.

AI systems rely heavily on patient data, raising concerns about privacy, security breaches, and the potential misuse of sensitive health information. This caveat is slowly causing heat in the application of AI in medical practices.

No one can refute that AI can streamline processes and enhance efficiency, but it may reduce the personalized interaction between healthcare providers and patients, which is crucial for empathy and emotional support. AI can perform amazing tasks, but at this time, the technology cannot hold a patient's hand or show compassion to a patient in pain or who is in a terminal condition.

Although AI can benefit a medical practice, it raises the heat for potential litigation. While AI can improve diagnostic accuracy, errors in data input or algorithmic functioning can still occur, potentially leading to incorrect diagnoses and improper treatment and creating a risk of malpractice and rising malpractice premiums.

Heat from American Disabilities Act (ADA)

Changes in healthcare policies and regulations add heat by influencing how medical practices operate, including reimbursement rates, privacy laws (e.g., GDPR, HIPAA), and standards for electronic health records. Another hot potato is making practices compliant with American Disabilities Act guidelines. Some attorneys are 'phishing" on the internet and even using drones to look at parking lots of medical practices to see if they are ADA compliant. Now, it is important to be sure your practice website is ADA-compliant. Examples of website compliance include volume controls for viewers with limited hearing, buttons to activate captions, screen reader compatibility, the text alternative that can activate text-to-voice for those that are sight impaired, and combability with refreshable braille displays to allow reading in braille through a particular terminal at the viewer's location. It is necessary to indicate with signage and on the website that the practice can arrange sign language interpretation. These requirements are being imposed on medical practices to ensure that the practice website is accessible to those with limited hearing and vision. Failure to do so puts the practice at an increased risk of fines and even litigation for failure to make the necessary modifications on the practice website.

The Americans with Disabilities Act (ADA) provides guidelines and standards to ensure that individuals with disabilities have equal access to goods, services, facilities, accommodations, and employment opportunities. For medical practices, ADA guidelines typically focus on accessibility for patients with disabilities. Here are some critical areas covered by ADA guidelines for medical practices:

Medical practices must have accessible entrances that are wide enough to accommodate wheelchairs and have accessible routes from parking areas or public transportation.

Designated accessible parking spaces must be provided close to the practice's accessible entrances, with signage indicating the accessible entrance.

Reception desks and waiting areas should be designed to accommodate individuals who use wheelchairs or other mobility aids. This includes providing accessible seating and clear floor space.

Restrooms must be accessible, with features like grab bars, accessible sinks, and adequate maneuvering space for wheelchairs.

Exam rooms and treatment areas must be designed to allow patients with disabilities to maneuver and transfer onto examination tables or chairs. This may involve adjustable height examination tables, grab bars, and adequate space for mobility devices.

The ADA requires that practices allow patients with disabilities to bring their service animals into the medical practice.

Medical practices need to evaluate their facilities and services to ensure compliance with ADA guidelines, providing equitable access to healthcare services for all patients, including those with disabilities.

Impact of the rising heat

The above examples have resulted in slowly increasing costs and rising overhead. Most of these technologies and compliance regulations have required additional staff, additional administrative personnel, and even legal fees to monitor healthcare regulatory compliance. Leasing or owning medical office space, maintenance costs, utilities, and property taxes contribute to overhead expenses. Rising real estate prices in some areas can further inflate these costs.

With the rise of defensive medicine, medical malpractice insurance premiums may increase. If litigation is brought against physicians or the practice, costly legal fees may be incurred.

These technologies come at a cost and slowly increase overhead costs. Investments in information technology, including hardware, software, cybersecurity measures, and maintenance, are essential but can be costly as practices implement these technologies to improve efficiency and control costs. Mostly, these technological additions are expensive and require costly ongoing IT support.

The purpose of this blog was to make us aware that we are experiencing incremental escalation of activities that distract from our purpose that we selected the healthcare profession, i.e., taking care of patients. When doctors are spending 2-4 hours a day on non-clinical activities, we are becoming discouraged, distracted, and dejected. I know there are multiple causes of the rising heat and there is not a single solution to cooling the rising temperature. In the next blog I will discuss a potential solution to the rising heat that is impacting so many of our practices.

Neil Baum is a physician in New Orleans and the author of The Business of Building and Managing a Healthcare Practice, Springer 2023