I think most regular readers of this blog know that I sometimes like to use big words, like plethora, tachycardia, and even penultimate. Sure, they won’t win any awards in terms of character count, but they are most definitely punching above their weight. I believe that today’s post continues in that fine tradition with the addition of mumpsimus. Mumpsimus refers to a tradition or custom that is adhered to even though it has been shown to be unreasonable. The word may have originated with a Catholic priest who mispronounced a Latin word and refused to correct himself after the error was pointed out. I am fascinated by this word and its possible origin, and I would like to propose some modern-day healthcare examples, at least from where I sit.
The pandemic gave us the opportunity to expose many mumpsimuses (sure, I prefer mumpsimi, but as my family and my boss at work continually point out to me, I don’t get to make the rules). Before the novel coronavirus became a thing, many people believed that virtual care could never replace the in-person office visit for many of our healthcare needs. Then practically overnight, most clinics closed, and virtual care was virtually the only care available. To the shock of many of us, life went on. In fact, in many cases, all the involved parties (patient, physician, and payer) preferred virtual care when it was appropriate (emphasis on the “when it was appropriate!”).
We may never be able to perform a complete physical exam when we are in different rooms, but there is a lot we can do virtually. Patients like the options that telehealth offers, and initial research shows that virtual care does not routinely lead to more in-person follow-up. Most reimbursement for virtual care is still in a temporary status in the United States, though, as the federal government seems only willing to allow “telehealth flexibilities” to extend until the end of 2024. Despite this two-year extension which will inevitably allow more data collection to influence the federal decision to permanently establish a range of telehealth reimbursements, people still doubt the future of telehealth efficacy. There is an assumption that many public (and likely then private) payers may return to the bad old days when most care occurred in clinics. I hope we don’t revisit those bad assumptions.
Another pandemic-related mumpsimus is the idea that the elderly are so lacking in tech savviness that they could never meaningfully interact with care providers online. Naturally, this is true of some of our aged, yet most proved that it was not their lack of ability but, more so, the inability of tech vendors to create the proper tools for them. Still, infrastructure needs like high-speed internet are an ongoing roadblock for many elderly, and this does indeed affect their capacity to take advantage of virtual care. As the reality that older Americans can meaningfully leverage tech tools comes to the forefront, I hope that apps and hardware become more geared for their use.
The idea that physician documentation must be an onerous and overbearing chore certainly rises to mumpsimus heights. It is true that doctors in the United States have been taught for decades that to get reimbursed for the care they provide, they must check boxes and notate often useless information. It shows in the average length of a progress note written by an American physician versus those who practice in other countries: the American progress note is four times longer! Yet, the documentation requirements were significantly simplified in 2021, allowing doctors to revert to the way we used to write progress notes, at least with respect to billing.
One might expect that given the new documentation paradigm, we would see remarkably shorter progress notes in short order. That has not seemed to happen, at least not yet. It may be that it takes time to reverse three decades of instruction and oversight. It may be that electronic health records (EHRs) haven’t been updated and configured to take advantage of newer templating options. It may be that physicians have internalized the need to put everything, including the kitchen sink, into their notes to overcome perceived deficiencies in data identification and visualization in the EHR. Whatever the causes, we need to move beyond this inaccurate idea that doctors’ progress notes must be encyclopedic.
While the original mumpsimus may simply be the mispronunciation of a Latin word, the healthcare beliefs and customs that I have outlined here can and do cause real-world problems. We should examine these ideas with a dispassionate eye, and if the evidence supports their discontinuation, we must work toward that end.