Tag continuity of care

The Standardization Tax, Part 4: Who Pays It and How

Someone will pay The Standardization Tax

A terminal cancer patient, offered a copay-free MRI, declines it. Instead, she chooses to keep her MRI at the hospital where all her doctors are. That decision anchors The Standardization Tax series' final argument: when a load-bearing wall comes down, someone pays for it. Physicians absorb unpaid time for conversations and documentation that the schedule doesn't allow. Patients absorb the cost of fragmented knowledge or flattened preferences. The post closes with practical advice on scope rather than sacrifice, and a direct, honest answer to the pre-med student who opened the series.

The Standardization Tax, Part 3: The Two Load-bearing Walls

Standardization and handoffs lead to knowledge lost

Post 2 in the series was about doubting your own judgment and attention enough to follow a checklist. This post is about doubting it enough to ask the patient what they want, and to trust knowledge you didn't personally build. It covers two kinds of load-bearing variation: the wall built by patient choice (Wennberg's preference-sensitive care and the shared decision-making it requires) and the wall built by a physician's earned knowledge of a patient over time, i.e., continuity of care. Standardizing either wall away doesn't reduce waste. It reduces choice or erases knowledge whose value nobody understood until it was gone.

The Standardization Tax: Not Every Tradeoff Is Worth It

continuity of care is a given in rural medicine

What would a pre-med student think if she heard how many doctors today say that they would steer their own kids away from medicine? They blame increasing corporatization, shrinking autonomy, and burgeoning documentation burden. These stem from increasing standardization in medicine. This post, the first in a series, introduces the idea that while standardization has benefits — catching errors, controlling costs, protecting clinician time — it also has a cost. Not all eliminated variation is waste.