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The Sad Tale of the USC Medical School Dean
It is unfortunate, that situation at USC Medical School, where the dean, Dr. Carmen A. Puliafito had been found in a Pasadena hotel room with a 21 year old woman in “provocative clothing” who overdosed on drugs. That happened in March 2016.
Allegations, pictures and even videos of Puliafito in the company of criminals and drug addicts had been popping up since 2015. There are many pictures of him enjoying recreational medicines. He was using methamphetamine and other drugs while serving as dean of the Keck School of Medicine. While there is nothing wrong with “partying”, the use of drugs and paying for prostitutes may be crossing the line.
It is sad, when a leader abuses his or her power and commits such errors in judgement. Why does this happen? Are they so high above the ordinary workers, do they make so much money that they feel infused with invincibility, are they beyond reproach, why do they suffer such ethical lapses?
Despite the vetting we mortal doctors go through to get privileges at a healthcare or teaching facility, why did USC not detect Puliafito’s ethical deficiencies? Too often, I hear that the institution reveres a candidate and after all, this one had a Wharton MBA. Institutions hate to insult candidates with pointed inquiries. Sometimes the little discovered nuggets of deficiency are considered just minor ethical oversights….we are all human.
So, this nonsense has been going on under USC’s nose for two years. I heard astonishingly, that USC is finally making plans to fire Puliafito. What? Another two year process?
If I was graduating from the USC Medical School, I am certain that Dean Puliafito will not be handing me my degree.
But he could be a hell of a party host that evening
The Future of Doctors
In the age of spiritual machines Ray Kurzweil in 2001 predicted:
By 2020, a $1,000 computer will match processing speed of the human brain – 20 billion calculations per second
By 2030 it will simulate the brain power of a small village about 1,000 human minds
By 2048 it will have the brain power of the entire population of the US.
I predict that within 20-30 years the computer will replace the venerable physician. Computers can already be programmed to detect sarcasm and read emotions. They can study your face and body language. Computerized psychotherapists or cybertherapy is soon to come. Programs can detect deviation from the standard pattern of human physiology, thinking and behavior. We can already program standards of care and integrate it into an electronic health record. The U.S. government program of Meaningful Use is forcing the adoption electronic health record use in 3 stages by 2017. As always, encouragement is by reward initially, followed by penalty in the later stages.
Now as you sit in a doctor’s office, you are likely yourself talking to yourself rather to your doctor who’s not spending any face-to-face time with you. He or she is likely staring at a computer screen and typing notes as you speak. Because of physician shortages or need to meet RVU targets (unit measure of patient care), your doctor has 10 to 15 minutes to spend with you. During that time your doctor has to document all key elements of the visit and check off various measures Meaningful Use but if you are lucky, a minute will actually be spent on a limited physical exam.
Compare that with the experience you had when you were younger. Decades ago my old family doctor sat in front of me, talked to me and talked with me. He would jot a few notes on paper. I got an examination and a treatment plan. He made me feel as if I had spent a long time with him. I would call that “meaningful.”
As the government, health insurers and hospitals demand greater efficiency, more documentation and of course, error free care, it is in their best interest to replace us with machines. There will no longer be any medical errors, malpractice will become history, and your doctor won’t be exhausted or troubled with anything so trivial as feelings. Who needs that sort of interaction because you are only here for a service. In the near future, we will be talking to a computer with voice recognition. We won’t miss the warmth of a patient-physician relationship since that will have been bled from our experience and our memory. It would be like the depiction in the movie, Elysium, when Matt Damon talks to a computer rather than a human parole officer with hilarious results.
The human physician will become history. Laying of the hands will be replaced by computerized probing and touch sensitive feelers, not by doctors, but by providers.
I can hardly wait.
More Stupid Hospital Documentation Rules
Today I was notified by Medical Records at my hospital that one of my OR/surgery reports was incomplete. I had done hemorrhoid surgery on a patient 6 weeks ago. Someone in the medical records department flagged a deficiency in my OR note. I had left out the “drain” section – whether a drain was used or not. For my lay readers, you need to know that while drains can be used in abdominal surgery, I have never used one for hemorrhoid surgery in 27 years. In fact I can’t think of any colorectal surgeon ever using a drain for hemorrhoidectomy. In any case I was in violation as the hospital Medical Record Procedure Committee stated that Drain recording is a requirement and has to be addressed in the Operative report. I was directed to Rules and Regulations page 14. Was the documentation of drains a ‘requirement’ of the committee because of government regulatory agency rules or did the committee feel that drains should be used in hemorrhoidectomy? I doubt anyone sitting on this committee knows anything about anal surgery, so it’s likely a misinterpretation or misapplication of a badly written regulation. If this documentation of drains is required, then this should be mentioned in all surgery despite clinical relevance or common sense. Taking this to a ridiculous end in my hospital, drain use should be documented for anal fissure surgery, removal of rectal foreign body and colonoscopy performed in the OR in spite of logic that drains are never used in these procedures. It is thoughtless mindless enforcement of such ‘rules’ and regulations which lead to more and more doctors leaving medicine in frustration.