Physicians Don’t Want to Be Told What to Do

It seems like a theme is cropping up around meaningful use. It has little to do with the regulations themselves. Instead it has to do with the fundamental concept of meaningful use essentially “Telling Physicians How They Should Practice.”

A comment on a previous post described it well when they said, “I am willing to bet that no matter what the final rule was, the majority of those involved in this industry would be upset with them.” It’s an enlightening point since I think it’s right on point.

It also illustrates that it’s not the meaningful use regulations that really bother people. Most physicians want to provide great care to their patients and many of the meaningful use requirements are no brainers. Physicians just don’t want to be told what someone else defines as great care. Physicians aren’t alone in this either. Just take a look at children’s reactions to their parents and you’ll see that for the most part humans don’t want to be told what to do and they kick against anything or anyone that tries to tell them what to do.

Anthony Guerra, founder and editor of Health System CIO, in an Information Week article highlights some similar points. He aptly points out that optimal performance is achieved not by issuing “prescriptive directives,” but by creating high level goals and let ownership of those goals take effect.

Anthony even suggests that the HITECH act money should have been spent to create a “set of best practices around EMR readiness assessment (think gap analysis), vendor selection, workflow redesign and system maintenance (think ASP/SaaS) for the providers that do care” While a certainly noble and worthy goal, I think there’s little evidence that this would have much impact. Why would doctors look to a government process to provide a best practice any better than they now look on meaningful use guidelines?

Meaningful use and the pile of EHR stimulus money reminds me a lot of a parent child relationship. The parents think they know what’s best and so they tell the child what they should do. The child kicks against those things regardless of whether it’s a good or a bad thing that the parent’s asking them to do. The parent then dangles the money in front of the child and says that if they want the money, then the child better do what the parent told them to do.

This is where we’re at with meaningful use. The parents (the government) have required something (meaningful use) of the children (the physicians) if they want the benefit (Stimulus Money). Now we’re waiting to see if the children will rebel or listen to their parents. I’m predicting physicians to be a little more rebellious than the average child. It’s not like the parents in this situation have a great history of past responsibility.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • But in this case the children have devoted their lives to finding the best ways to manage illness, and are the only ones held accountable when something goes wrong. The parents, on the other hand, have eggregiously intruded on their work flow, demanded short-sighted and counterproductive “quality measures” (remember the antibiotics in pneumonia example?), and have shown time and time again they are insensitive to the demands of real patient care, have only a vague and simplistic understanding of the science and how it should be applied, and have never provided any evidence that electronic medical records provide benefit. The parents, unlike the children, don’t know enough about medicine to understand the implications of their decisions, or the meaning of unintended consequences. Better analogies, please.

  • Still seems like a good analogy. The less responsible the parents, the less the children respect the parents and listen to what they say, no?

  • In this case, the parent is asking the child to do something that is a greater good for the society.
    Agreed, the parent has not always been responsible or known to make the best decisions (then again, which parent has proved to be perfect?).

    I haven’t seen any independent observer saying the parents goals are flawed. Yes, the method and actual steps may have flaws. We can argue whether 30% of CPOE is good enough we need 80%. Digitizing medical records is not a bad idea, is it?

    Children can and will rebel, but who will be hurt more? Parents or the children or the remainder society?


  • To reconcile the many perspectives on this issue, I think it’s useful to remember that a family can consist of more than one child, and even more than one set of parents. After all, physicians are responsible to more than one gov’t agency, and all providers are not created, taught, or practice equally.

    In my own family, it’s sometimes difficult for me and my mother to talk “tech,” while with my father it’s near impossible. That’s not because either is more qualified than the other, but my father has never had to use technology much in his life; ergo, he’s never learned as much, and thus has less perspective than my mother, who has had to adapt to the increased use of technology in her daily work life. Similarly, the type and amount of tech that I and each of my siblings use in our work is vastly different.

    When you’re talking about workflow, you sometimes have to ask yourself what exactly that means. Sometimes it depends on your individual perspective. Mandating that everyone in my family use the same type of computer would probably not be in anyone’s best interests. However, we all use email and cell phones to communicate with each other.

    Fierce HealthIT reported recently that the “Most Wired” hospitals are looking at meaningful use more like “guidelines rather than actual rules,” (to use the famous Pirates quote). Isn’t widespread EHR adoption that improves a clinician’s practice of medicine is met the ultimate goal?

  • “Isn’t widespread EHR adoption that improves a clinician’s practice of medicine is met the ultimate goal?”

    Depends on who you ask. I’d guess for many doctors their goal is the best patient care with the most profits.

  • Should have clarified that last sentence I see: I meant the ultimate goal of providing incentives for purchasing an EHR. I certainly believe most offices would look at cost-efficiency when weighing their options, and honesty, why shouldn’t they? (and one day I’m going to remember that the em tag on this site leads to bolding, not italics)

  • I look at this topic and can think of just one word, “regulation.” At the end of the day that is essentially what we’re talking about here except that in this case it is not the mandatory type of government regulation that we are used to,. It’s an opt-in for benefits effort with a potential for backlash down the road if you choose to opt-out. Which in this case seems to me like childish scare-tactics.

    It’s no mystery that many in the Health Care space are of the mind that the medicare penalties will be delayed if not downright written out entirely.

    What’s really stuck in my craw about all of this though is the fact that it’s opt-in for benefits or opt-out for a scary, incorporeal penalty. There’s a choice, but not really much of a choice. So why doesn’t the government just come out and say what they realy want and make all of this sraight-up mandatory. I say if you’re going to ask someone to do something with a threat of backlash when they don’t, you might as well come out and just say what you want; that what you’re asking for is mandatory.

    There’s a giant flaw that needs to be exposed though, and that is things in the real world aren’t so black and white that these changes could be rolled out across the board in a compulsory fashion.

    My one and only example here is the small-town doctor in rural America, where nearly all of the benefits this legislation is designed to achieve are null.

    So I guess what I’m saying is that this whole model of a carrot on a string to incentivize doctors to opt-in with the proverbial lawn mower behind us to chip away at our income should be lax and get left behind is just disingenuous.

  • “Isn’t widespread EHR adoption that improves a clinician’s practice of medicine is met the ultimate goal?”

    And I thought the original reform objective was to improve the wellness posture of Americans.

    By definining universal EHR adoption and Federally regulated “meaningful use” standards … the quality bar is now set to no higher than where the government defined it to be.

    There is now a presumption that the academians, regulators, and software vendors know how to improve America’s health care and wellness posture better than medical professionals.

    Medical professionals deal with patients as individuals … while reform initiatives would define care protocols which physicians will be required to abide by … independant of the patient’s specifics.

  • As for the analogy … I think most medical professionals might take issue with that portrayal.

    Parents must … and do demonstrate far more wisdom, common sense, and fairness than the government has ever demonstrated.

    Further … in my opinion considering licensed health care professionals who have sworn an oath as children in this analogy is demeaning.

  • @Don B,
    I guess I could see how someone could take the analogy as demeaning. However, that wasn’t the intent. People can take the analogy or not. There were just far too many parallels between a parent that wants a child to do something (and holds the purse strings) and a child who doesn’t want to do that thing with the current EMR stimulus situation. That doesn’t imply that healthcare professionals are children and exhibit child like characteristics. It’s just an analogy to consider what might be learned from the relationships of a child with the parent that could be applied to the EMR stimulus.

    People are certainly welcome to disagree. Good thing is there’s already another fresh blog post up for today.

  • Penalties will be rolled back when seniors scream at their elected representatives that their PCP told them that they had no alternative but to pull out of Medicare rather than accept further revenue penalties for not meeting governement defined EHR “meaningful use” standards.

  • @John… Okay. How about Ebenezer Scrooge (government) and Bob Cratchit (health care providers)?

Click here to post a comment