Today’s Healthcare System? I Say Humbug!
A Time for Reflection and Anticipation
By George Martin, MD – Senior Medical Director for Health Integrated
Welcome to years end, a time for reflection, and soon to the New Year and a time for planning. This week and next we will do both. First, the reflection:
For many of us, college is far too far in the past. Personally, mine started with physics as a major. In the midst of my junior year, there was a realization of two things:
- Physics was boring
- The were no jobs in physics
A good friend was completing his PhD. He sent out 200 resumes and only got 2 responses. Thus my ensuing career change to medicine, which has not been boring. For those of you who follow the developments in physics, that has not been boring either. But I digress.
For the past year, we have focused on the needs of patients for care management services. Frankly, coordination and continuity of care in the US stinks. With rare exceptions there is no system. One cannot even be admitted to a hospital without answering the same demographics questions multiple times. Must have been a Freudian slip, but initially, I wrote “tomes” instead of “times”. It certainly feels like tomes when answering the same questions the third time being admitted to the same facility you were at 3 weeks ago.
Systems do not talk to each other. Providers don’t talk to each other. No one asks the end users for input about the needs to perform their tasks. If you begin to feel the frustration, that is my intent. And yet we progress. Somehow and some times, in spite of our self. Often it feels like one step forward and two steps back. But it is motion. And things change. Like it or loathe it, we have a health care reform bill chugging along and we are all changing our behavior to meet the mandates.
Someone must begin to take responsibility for the management of the care each individual receives. I can see only two choices:
1. A comprehensive and possibly coercive care management system will develop with the focus on cost containment. Such a system could eventually include rationing and end of life exclusions without patient choice. Such a system, of necessity, would be focused on the needs of the collective.
2. We design and implement a system that meets the needs of the individual patient and empowers each of them to manage their own life and their associated healthcare. Such a system would provide needed support but require individual responsibility.
Thus the conundrum of our times. Does our system become one of central planning and control or do we allow for failure to achieve healthcare goals knowing that when an individual fails they may pay, literally, with their life.
Wherever you decide to enter this discussion, it also applies to the wider scope of life in these United States of America. This is a philosophical difference that has little room for compromise. To compromise here is essentially to admit that one has no core beliefs and perhaps no moral compass. Free choice as the morality of either can be supported but the choice is collective responsibility versus personal responsibility.
Are you as frustrated as I am? What do you think? You can reach me directly at healthexecforum@healthintegrated.com, or comment directly in the blog.
As always, thanks for reading and for your input.
George Martin, MD
Great thoughts! Technology has improved dramatically, Care has devolved dramatically. Systematically putting the Care back into healthcare is the greatest challenge for Western medicine – worthy of a Nobel prize in medicine in my opinion.
I couldn’t agree more. How can we get enough momentum going to make a difference?
I’m not sure it’s about momentum, rather it’s about leadership and cooperation. It seems to also help if you don’t care who gets the credit for the success. I believe it starts by leading by example and providing alternatives for patients that put the care back into health care. Patients know the difference when they experience it.
There are many elements that can be systematically integrated into care (see Disneyland for a great example). Once, my family stayed at Disneyland hotel and our maidput our kids stuffed animals in creative places and fun poses everyday. They couldn’t wait to get back to the hotel everynight. I thought we had the best maid ever! I then read Walt’s biography and found out that was part of their training and had been going on for decades. He believed in “plus”ing the experience for patrons. The same can be done for patient care. Our docs and staff have been working on systems, processes and technology that enhance relationships and lus patients and doctors experiences for almost 10 years and now we have a 2 year waiting list to get into our non-concierge practice that is integrated into a multi-speciality Wellness center, surgery center, integrated with the local hospital, includes a restaurant, day spa, etc. Showing docs and patients a better way is the start. Expanding our minds beyond evidence-based medicine (which is always 5-10 years behind with an overreliance on metanalysis) and cost-effective micromanaging medical decisions (as oppossed to life-span, relationship centered macromanaging) will be our ticket. It will take courage, vision and leadership that is beyond politics and low-reaching guidelines to make healthcare great (and affordable). It can be done. It must be done. We can only do it if we all work together with the same commitment.
Leadership is important and Disney has long known about that and a focus on the customers and their experience. Health care is fragmented leading to a spotty record for leadership and no idea of who the customer is.