Has anyone really given a thought to the plight of the small (and large!) physician as a result of all of the proposed reforms in healthcare? Doctors, to a large extent, seem to have been made scapegoats in the battle for healthcare reform. At the same time, true reform is impossible without doctors participating willingly and eagerly. An incredibly ironic situation, but ripe for disaster in the making.
Not so long ago, doctors were professionals who were primarily focused on clinical care. Today they are focused on clinical care + practice management + claims management + IT implementation + legal concerns +..... the list is almost endless. Add to this, the pressure of society's sole barometer for success being financial, and the burden becomes a mountain.
In the face of these overwhelming yet invariably contradictory forces, clinical practice today has become almost impossibly challenging for even the most committed of doctors. Everyone, literally EVERYONE, has complaints against the quality of medical care today. Almost invariably the blame for this is brought to rest at the doctor's door.
I would think that given this state of affairs, one of the first places to look to actually implement true reform is the doctor and the doctor - patient relationship! But, this is the last area that is being actually seriously looked at, if at all!.
We hear strong statements about EHR implementation, P4P, Universal insurance, Executive consortium meetings, ARRA etc etc. Shouldn't we also be hearing, equally stridently; about physician support, physician value proposition, medical education reforms, relationship management, clinical decision support systems, knowledge management value to clinicians etc etc....?
So let me make a somewhat radical statement - and I GENUINELY hope I will be proved wrong.
In spite of the wonderful noises being made on healthcare reform, very little or no improvement will be seen in the healthcare industry's functioning by 2018 that can be DIRECTLY attributed to the reforms being proposed. Natural balancing systems of supply, demand and the cultural inflexibility of the industry's clinical and administrative bureaucracy will more than compensate for any 'business level' changes that are being attempted.
I propose that the ONLY way to bring about any serious healthcare reform is to target the 2 KEY participants in this industry. The doctor and the patient. The best analogy I have found to clearly, completely and concisely explain this fact is to give the following analogy.
Imagine that for some reason - it may well be needed, but is not my area of expertise :-) - the practice of religion needed to be reformed! Would you not first look at the behaviour of the priest and the believer?
Healthcare is as personal, emotional, individual and sometimes illogical to the patient and practitioner as religion is to the believer and priest.
Essentially the foundation of healthcare lies in trust, respect and belief between these two 2 key participants. This may well be less true in highly 'developed' countries compared to 'developing' countries (a potentially endless topic of debate), but still remains the key to reforming the industry.
Thus:
1) Reform medical education.
Essentially catch them early and mould physicians into the right attitudes and character required to genuinely provide the best possible care. Make Medical Education truly holistic in ALL aspects of caring for a patient; not just in the area of academic knowledge.
2) Empower the physician with the best possible knowledge management tools and technologies available.
Medical knowledge has gone beyond the ability of any single human being to completely encompass even within a single specialised or super-specialised area. This is not via just data collection through EHR/EMR but a need for a serious focus on intelligent decision support and knowledge management tools. If we don't execute this, physicians (and therefore the industry) will increasingly lose sight of the holistic aspect of patient care in an effort to keep pace with knowing everything about a single area of speciality.
3) Empower the patient with substantially more medical knowledge and authority than he / she possesses today.
Level the playing field and balance the relationship between the physician and the patient. These 2 players should be true partners and drivers of the industry!
Only if you do the above, even to a partial extent, will the 'reforms' proposed today have any chance of truly reforming the industry!
In the words of the great poet Rabindranath Tagore:
Where the mind is without fear and the head is held high;
Where knowledge is free;
Where the world has not been broken up into fragments by narrow domestic walls;
Where words come out from the depth of truth;
Where tireless striving stretches its arms towards perfection;
Where the clear stream of reason has not lost its way into the dreary desert sand of dead habit;
Where the mind is led forward by thee into ever-widening thought and action--
Into that heaven of freedom, my Father, let my country awake.
Replace 'country' with 'healthcare industry' and you will perhaps be even more relevant!! It definitely can't be done without the physician!
