Ah, the miracle of Big Data shall sweep in and rescue us!  Not only will it improve the job of the physician (or eliminate it entirely), it will usher in a Bold New World of medicine – self-driven patient driver-side medicine!  The miracles due us are not unlike when the Easter Islanders – who for centuries had been far disconnected from every other civilization on the planet, and forgot whether their stories of Others were fables or not – suddenly saw a foreign ship on the horizon for the first time in three hundred years.  They knew that redemption and salvation was at hand.  (Actually, Spanish colonization was at hand, not quite what they anticipated.)

I have just danced with big data – it does not impress me.  I had to complete a C&P, credentialing and privileging packet, a chore which I’ve always considered onerous.  It has become far more so over the recent few years.

Doctors are perhaps the most heavily documented private employees on the planet.  No doubt, the CIA and Secret Service rigorously research their recruits, perhaps also the NSA does as well – but these are Government employees.  All doctors know quite well that every week of their life must be accounted for, and if you were not toilet-trained by the age of three, you need a notarized document from your mother to explain why.

The new rage is the e-transcript.  To the modern HR eagles, a simple diploma is not enough – it could be forged!  (Actually, the market in China for document forgeries is supposed to be quite sophisticated.  You can get whatever you want.)  Now, they want a transcript.  Some schools have contracted to use electronic publishers, and some still do it by mail.  My medical school sends these out by mail – and since everyone wants a “CERTIFIED COPY” of the transcript, they are once again bugged to send it out in the mail.  I was chastised for this – the C&P people needed a CERTIFIED ELECTRONIC version of the transcript, notwithstanding the fact that the Medical School produces no such critter.  At this, the Hive Mind must be consulted; the vacant stare and slight drool indicates that the attention has been turned elsewhere.

I was approached for my green card/J1 visa.  This seems rather peculiar, although many people do not recognize Las Vegas, Nevada as part of our planet.  Notwithstanding, I protested that I am a proper American – I’ve only been to Tijuana and Ensenada, twice.

The National Credentials Verification Service, is an uber think-tank that brings verification of credentials into the 21st century, we are told.  All the Boards turn to them for the Right Answer at the Right Time.

But I made the mistake of going to MIT, the boring old one in Cambridge, Massachusetts, as an undergraduate.  There are actually MANY MIT’s that come to mind; and the FCVS boldly certified that I was a graduate from the MIT College of Management, part of Punjab Technical University in Pune, India.  No doubt a worthy place – but not my alma mater.  Of course, that opened up a whole cluster of questions – residence, documentation and other things.  Some people from the Red States might consider Cambridge, Massachusetts not  a part of our Grand Republic; but this is not a political subtlety.

And bad data, like our commensal species brought along with human civilization, tend to wreck the foliage and drive the local species into extinction.  We allow data to breed without appropriate contraception; it is eagerly spread like syphilis through the community.

Bad data is sexy, too.  If you, friend, have 10 background reports that show you to be a boring Midwestern Republican, and one that shows you did time in a Turkish Prison for killing an underboss of the heroin trade, welll…..which one will be the most fun for your local TV station to report?  Bad data has an evolutionary advantage – everyone wants one of those suckers.

All these things that I had ignored.  The Federal Government gave us all the six-six-six some time ago, with the UNIVERSAL Provider Information Number, might as well get it tattooed on your hand, ‘coz that was your new name.  Then, a few years later, the NPI/NPIN was hastily distributed, as the UPIN wasnt…enough.  I have not worked providing care in a facility that used electronic records since 1999.  Therefore, my meaningless futilization is subdeficient, and must be actualized.  I was pushed off the list of providers some years ago, apparently, in one of the Federal programs, because of that.  Now, I have to reapply and explain why.

Never ignore a request from a bureaucrat to explain something.  It is a trick of the trade.  You, the chump, believe that facts dictate actions – explain away!  Bring graphs, yes!  Powerpoint!  Nobody is listening; it’s just you giving yourself a chance to blow off steam before you are punished.  The plans were made before your explanation was sought – being convincing is not necessary.

I hear tell that the NPI/NPIN Database clashes with the CMS/UPIN database, and the prevalence of correctness of the two matching each other AND reality is about seven percent, on a provider basis.  Now that Large Data is at hand, without correlation, it has no relevance.  I could here type out the fourth root of the number 25; but what would be accomplished by doing so?

In nearly every culture, the tidal wave caves in on the bureaucrats, who are still shouting at it that it is not regulated – it is not according to policy, therefore it must go away.  They wave papers at the great undulations looming over them – get lost!   You are unauthorized!!  China has been civilized for perhaps 6000 years; and bureaucratized for much of that time.  They know how to ride the wave, and keep from drowning.  I’m afraid that we don’t.

If you want to see what the future looks like, it looks and awful lot like credentialing and privileging.  Once the process gets too easy, the regulators have at it, the way that they take on the medical note.  “What was your grandmother’s birthweight, and why isn’t it documented?  Not documented is not done,” goes the most stupid legal saying in the history of the planet, I expect.

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