McDonaldization of medicine

Interesting post by Ray Dorsey in JAMA Neurololgy. If you are like me you will not have come across a neurology journal here http://archneur.jamanetwork.com/article.aspx?articleid=2469513

The authors relate what we all see around us: the "principles of the fast-food restaurant—efficiency, calculability, predictability, and control" applied to medicine.

They take each of these four principles and point to problems when applied to medicine in the extreme. No one (at least rational) will argue that we need these principles to challenge us to aspire to be better but taken to the nth degree, what are the consequences?

For instance they say that efficiency taken too far may lead to long lines and mistakes by workers pushed to do more with less leaving patients at a loss. Calculability or emphasis on numbers taken too far may shift the focus from humanistic care to speed. Predictaibility as per Demling may lead to a predictably mistake free car but what if individual patients require more or less time to solve their problem? Finally, controlthrough technology has the possibility of generating more precise data to allow better modeling but at what cost? Physicians are already unhappy at the enormous time spent on their computer rather than looking at patients, who are similarly upset at being objects rather than persons.

The article is however an emotional piece. True but lacks real solutions. As long as the healthcare system is led by people who are not accountable to the people and there is lack of transparency, patients and physicians have little say. Part of the solution is both stakeholders pushing to be in control and be at the table in decision making to make sure their voices are heard in the jumble of technology and finance.