To practice medicine in the twentieth century was to be a purveyor of health in a Golden Era. At the center sat the physician around whom all medical questions and concerns revolved. Much like the sun at the center of our universe, the physician was one constant that could always be counted on and trusted. The physician’s hope was a sunrise, and their final word set like the sun on a horizon. Patients expected physicians not merely to provide a service, but to bequeath upon them the tools to become healthy, to bless them with the knowledge and potions that would ease their suffering. If the physician did not succeed, it was akin to god not succeeding. Nothing more could be done.
Now, that era is over. The old timers will tell you, the middle timers will tell you, the greenheads will hope to god they’re lying. No longer is the physician seen as the end all be all, but simply another customer care professional, a cog in the hospitality wheel meant to provide a service. Don’t like the service? Shop around. Don’t like the result? Get a refund. And more and more the atmosphere of healthcare is purveying this attitude.
The New York Times published an Op-Ed by Adam Frank in August 2013 called “Welcome to the Age of Denial,” wherein Frank discusses the shift in popular science trends in America. While science was once an impenetrable and venerable force shining light on the intricacies of the unknown world, it is beginning to be questioned by the lay masses and turned into bargaining chips by political officials who pander rather than lead. While he does not discuss medicine, it is a short extrapolation to see this same tidal shift happening in our realm. Politicians are moving the medical model around like a eight year old with an erector set, while patients come to offices pre-diagnosed by WebMD, or even more recently, crowdsourcing.
The Boston Globe published an article in August 2013 called “Can Crowdsourcing find the right diagnosis?” The article discusses savvy entrepreneurs who take advantage of this laypeople trend of surfing the net for health information (instead of heading to their PCP and asking questions to a skilled professional). On the surface, the idea of thousands of individuals being able to collaborate on a problem instead of one or two doctors may sound like a logical concession. Much like a first year medical student trying to create a case presentation, however, inexperienced people neither know where to look to find the most validated information, nor do they have the breadth and years of experience of a practicing doctor. The knowledge that is distilled is often confounded by biased sources and not backed by research. Furthermore, the results come from a population not of n=10,000, but rather n=1x10,000: thousands of individual, narrow and unrelated experiences somehow collaged into a mismatched puzzle of answers. But the doctor can’t have all the answers, right?
Another trend spreading across the medical landscape are Urgent Care clinics. Patients have been responding well to these “Docs-in-a-box” wherein the cost is often far below an ER visit, and the convenience of strolling into a local center at a whim, instead of following closely with a PCP, is a temptation oft conceded. Savvy doctors are moving into this model, seeing it as a trend that is going to overtake the current medical structure. By taking advantage of a superficially positive trend, however, they may be undermining a salvageable system that has far more potential for both doctors and patients.
I don’t want to practice medicine in a climate where doctors are regarded as imperfect sources of information. I don’t want to practice medicine where my decisions are based on panels of politicians and insurance companies skimming for cost-based efficiency without real in-the-trenches doctor perceptions on the decisions they make. This is the tidal wave toppling our towers, and we’re holding up our hands in a futile attempt to hold back the waters.
I don’t believe it has to be this way. In his articles “Health Orgs Dooming Their Innovation to Failure” and “What’s the Role of a Hospital in Ten Years?” published on Forbes.com in June and July respectively, Avado CEO David Chase explores the realm of healthcare as an antiquated and moth-nibbled entity that desperately needs an update. Avado is a patient-relationship management entity, the kind of company that is taking advantage of some of the winds of change instead of closing the window and rebreathing stale air. While I recommend both articles, I will extract only this quotation:
In practice, the most important medical “instrument” for the organizations that have tackled tough populations of patients (e.g., low income, multiple chronic conditions) is communication.
In medical school, this is our most reinforced lesson: talk to your patients. We’re battered by our professors, implored by our attendings: Your patient will tell you the diagnosis! Ask the right questions and let them talk! The more you communicate with your patients, the less likely they are to turn around and sue you! It seems so simple and maybe was, once upon a time in that Golden Era.
However, in reference to the sentiment of David Chase, doctors have an opportunity in the current technological and social climate to truly reach out and affect their patients. For example, through patient-doctor management portals, patients can pose questions to physicians who can then provide assurance or direction. Minor questions and concerns that before may have occupied valuable office time can now be addressed formally, but more simply, through such a portal. In such a program, patients could also visualize their complete history of test results trended out to see their progress (or lack thereof) and physicians, too, can comment and guide. These are mere seedlings of possibilities.
Imagine a world, for example, where blood-glucose monitors uploaded directly to a patient portal, automatically imprinting that information on a patient record. Doctors could comment on sugar swings, forcing patients to be even more active in their care. Patients could upload diet logs and weight loss/gain, prompting responses from their physicians. Imagine a system where doctors could upload short videos briefly educating their patients on their condition and providing guidance, for example, to cease smoking, instead of intermittently suggesting such ideas at a yearly checkup.
These innovations may sound like more work, but this work could serve as a case for reimbursement just as in-office counseling can be reimbursed. Consistent and constant preventative care in the moment should, theoretically, cost less over the long run. Insurance companies should be excited to pay for these kinds of innovations. Doctors, too, should be excited, because if insurance companies try to ding them for frequent hospital admissions or patients who don’t improve, they will be able to showcase a timeline of consistent intervention that puts the insurance ball in the patient’s court, where it should be. When doctors take care of patients who don’t take care of themselves, doctors should not be the ones penalized.
Times have changed and are changing still, which is why it is important for innovative physicians to voice new perspectives on new ideas instead of holding fast to wistful times now passed. Doctors may feel like they are walking uphill against a stiff breeze, but a simple shift in stance from old-to-new ideas can put those winds of change in our favor. If we can flip their direction instead of shutting them out, we may see a more effective, and less costly, age of medicine to come. After all, maybe the previous era wasn’t golden, but gilded after all.
