Grand Theft Medicine: The Video Game


A SERMO Internal Medicine and Infectious Disease specialist has created the basis of a new physician-centered game…

Grand Theft Medicine: The Video Game


I have practiced medicine for 35 years, 28 of those years focusing on HIV medicine. For the past 14 years I have practiced primary care and HIV medicine at a community health center, and for the past nine years have endured the intrusion of Electronic Medical Records into my practice.

I now realize that gradually over these past seven years of EMR, my daily routine has become essentially a not-very-enjoyable video game. Here is a description of this not-ready-for-prime-time video game:

Like most video games currently on the market, this game is played in a darkened room, with a keyboard and a mouse (I suspect someone somewhere is working on a controller for this game). As you navigate through the labyrinth of this game, you encounter your enemies:

1. The Acronyms: These odious entities include the PCMHs, the ACOs, the PPACAs, the NCQAs, and the JCAHOs, among countless others. Each of them has a voluminous set of rules which must be satisfied during every round of the game.

2. The Regulators: A subset of the Acronyms, including HRSA, CMS, Part A, and the dreaded Grantors (a peculiarity only in the variety of the game I play, called FQHC). Again, each has a daunting armory of requirements that must be negotiated with to successfully complete a round.

3. The Deniers: You know them … Aetna, United Healthcare, Fidelis, and on and on. Part of what’s so scary about the Deniers is that there are so many of them and each one of them employs slight variations of a huge catalogue of obstacles that must be continually negotiated. The penalties they mete out include Prior Authorizations and Formulary Changes which can change from round to round and day to day. Stay on your toes for thvese guys!

4. The Litigators: A shadowy group which hovers in the background of each round, and will pounce on any slight miscalculation and ruin your day.

5. The ICD-10s: Even the creators of the game don’t seem to understand these monsters and always are under or overestimating their demands on the player.

So now we play the game! I should point out that this game is produced by many different manufacturers and designers, so if you play in more than one place, you’ll have to learn a whole new set of control commands to play successfully (not to mention safely and reimbursably – the latter is always the paramount design consideration, of course!).

Because there are so many different and complex variations, and because they are written by people who never actually play the game, these programs are buggy … shutting down, freezing, jumping from screen-to-screen and level-to-level with maddening unpredictability. They often are also unpredictably slow at times due to the complexity of the game … yet speed is always of the essence. Have fun!

Oh, I forgot to mention that there are the Unexpecteds and the Queues! These are bits and pieces that pop up randomly during play and must be addressed to complete the game. They can include Phone Messages, Lab reports, Diagnostic Imaging reports, Messages, Actions, Electronic prescriptions and others that I can’t even remember.

So every day now, with over three decades of experience in clinical medicine, I play this game for which I am totally unprepared. Of course, the goal is to get through as many rounds as you can each day. Sometimes the game is so exciting I continue to play when I go home (I never used to be able to do that before).

And one more thing … in between every round, there is something called “Patients” which requires that you leave the playstation and interact with some human beings who do not understand or play this game at all. They want to steal your time and distract you from the fun you are having in your office!

There may also be “Staff” who actually can intrude into the game at times, but at other times also try to distract you from your play.

This game is so complex you’d think it would have a small market and be tough to sell … but fortunately for the manufacturers, our political leaders, who will never, ever, play this game and who have very limited evidence that it is a good or useful game, have mandated that all doctors buy and play it. Gee, thanks!

And yet I have this nagging feeling that this game could be much simpler, and that a desire to help Patients was why I went into medicine. Can somebody help me out here?


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