Doing nothing is sometimes doing something.

As part of Obamacare, Medicare won’t pay hospitals for patients who are re-admitted for the same condition within 30 days of being discharged from the hospital. Because our hospitals profit off sickness, prior to this, hospitals would discharge patients half well and then make more money by re-admitting the patient. Medicare is trying to change this profiteering. So hospitals are investing in care coordinators to keep people out of the hospital for at least 30 days assuming that an investment in care coordinators will make up for the losses from readmissions that aren’t reimbursed.  


In 2011 the Department of Veterans Affairs halted a program in which patients with chronic lung disease were supposed to learn to take better care of themselves (via a care coordinator) when 28 patients in the program died, in contrast to 10 deaths in the group receiving typical care.

Typical care meaning patients go home and only half understand their plan. Fascinating for a few reasons. First, Obamacare legislates the practice of medicine that may actually be more harmful than good. And second, is sometimes the best thing to do is stay away from care and not follow the doctor’s orders upon discharge? Are intensive, by the books, treatment plans instituted upon discharge doing more harm than good? 

One of the main issues in healthcare is that doctors must do something. It’s very difficult for them psychologically and legally to just do nothing. We’re doctors. A pat on the back isn’t the same thing as tangible medications designed to change some chemical process in your body. It’s what we do. It’s what the public expects. And it’s what holds up in court. Sometimes I wish we could just prescribe a placebo, like they do in Germany. We’d probably be a healthier country.