Wednesday, August 26, 2015

I'm taking back medicine

I’m taking back medicine.

If you didn’t know it left or that someone stole it, I’ll give you a pass. Medicine has been disguised for a long time now. And, when you leave the scene in camouflage, you often go unnoticed.

Medicine is supposed to be the science or practice of diagnosing, treating, and preventing disease. I love medicine. There’s so much to learn. Lots of complexities and so many people to help. Medicine gives me an avenue to serve, because if we don’t have our health, what do we have? Illness. And, none of us want that.

I’ve trained to be a physician. I’ve learned lots of things that can help you with sickness. But, in order to do this, they have to let me practice. And, yes, they are the people who have taken medicine.
When did medicine become more about meeting than doing? When I first became interested in medicine, physicians worked. We worked days and nights, hours on end. We learned by working. We worked by doing. And, things weren’t perfect then. But, we took care of patients by actually doing something that literally moved the needle. 

Now, it’s different. We just meet about it.

Toward the end of my medical training, administrative meetings were already running rampant. We’d meet because some group said we should be doing a quality improvement project. Just some new regulatory thing. Gotta come up with a project. Every year.

News flash for the folks scheduling meetings: that’s not how innovation works.

Bureaucracies don’t drive innovation. Never have. Never will. I’ll tell you how we did those practice improvement projects that someone else told us we should be doing. We usually would type up some protocol that we were already doing and then add it as another formal policy. Box checked. That’s what humans do when they are given futile tasks with poor incentives.

Meetings in health care have really just become smokescreens for government-driven busywork. Sure, they can be functional, and in fact, they always add more functions for all of us to be doing. But, most of the time these meetings aren’t productive for patient care because they’ve lost sight of the one thing medicine was built upon: the patient-physician relationship.

Take a look at the graph included here (below). It outlines the growth of administrators in health care compared to physicians over the last forty years. And, it includes an overlay of America’s health care spending over that same time. Take a look at the yellow color. A picture is worth a thousand words, isn’t it?

You see, when you have that much administration, what you really have is a bunch of meetings. Lots of folks carrying their coffee from place to place. They are meeting about more policies, more protocols to satisfy government-created nonsense. But, this type of thing in health care isn’t fixing things. It’s not moving the needle.

What moves things is innovation. And, innovation isn’t some concept that responds to being forced. It develops when the right chemicals exist in the right moment for an exciting explosion. It happens when someone in a free-market recognizes a problem and creates a business idea to solve it. But, we’ve completely lost this environment for innovation in health care. Medicine has been kidnapped by a bunch of government-driven regulations that cost billions of unnecessary taxpayer dollars for oversight...

But, the point I’m making is that the bureaucracy has exploded out of control. When you have so many excessive regulations that you need that many people overseeing checkboxes instead of delivering medical care, you aren’t just stifling innovation, you are having untoward effects on cost control. Medicine used to be about you and me. In fact, where in the world did the patient-physician relationship go? I guess that it left when Medicine did.

I don’t care what you do. You can take me out, join me, or get out of my way. But, I’m on a mission to take medicine back.
Courtesy of:

1 comment:

  1. After obtaining two Ivy League degrees, I turned down lucrative job offers in finance and consulting, choosing instead to take out $180,000 in loans, the national average for medical students in America. A decade of post-graduate education later, I now work 60 to 80 hours a week for $13 to $20 an hour. Yes, you read that correctly. Resident salaries are paid for by Medicare funding, so I make less as a doctor than I did waiting tables in high school.

    Over the years, I have made all of these sacrifices willingly and gladly because I am fiercely in love with medicine. That is why I refuse to let this profession slip any further into despair — pulled apart by ravenous malpractice lawyers, administrative overhead, and insurance companies....

    But there is hope, and we need to look to each other for inspiration.

    Take Dr. Pamela Wible, who founded the ideal clinic after a series of town hall meetings led by members of the community she cares for. These clinics operate around principles valuing physician autonomy, direct patient contact, and disintermediation. By eliminating wasteful administrative overhead, she now spends between 30 to 60 minutes with each patient, is never double-booked and earns three times as much as a hospital employee. She works with patients in her communities, so no one is ever turned away due to lack of financial resources.

    Dr. Garrison Bliss from Seattle provides us with another model. Fed up with the assembly-line feel of traditional medicine, Dr. Bliss helped start Qliance. His company is modeled after concierge medicine, but aimed at providing personalized health care at a reasonable price. Members pay less than $100 a month to receive unlimited access to physicians for routine and preventative health care like flu shots, blood tests, diabetes and cholesterol counseling. If his patients require more complex care by a specialist, he travels with them to office visits, serving as an interpreter and friend. His company is helping to manage the care of over 35,000 people — from Medicaid patients to Seattle firefighters to Expedia employees.

    Innovation is occurring on a larger scale as well. Stanford University recently implemented a novel “time-banking” program aimed at reducing physician burnout. This plan allows doctors to trade important but often-uncompensated work like mentoring and committee leadership for home-related services such as grocery shopping, babysitting, dry cleaning, and grant writing. Physicians in this program are not only happier, but they’re also more productive.

    Members of this program had more grant proposals accepted than their peers and contributed to over $10 million in funds. The total cost of this program is $250,000 for two years, less than 1 percent of the department’s annual operating budget. It’s not only improving the lives of physicians, it’s also financially viable. By enhancing work-life balance, it has the added benefit of attracting more women and minorities, two groups severely underrepresented in many medical specialties.

    I’m not advocating that you join Stanford, move to Seattle, or open your own ideal clinic. I simply want to remind you of something that we seem to have forgotten as a group. We hold a tremendous amount of power. We have traveled the globe, worked in academic medical centers and spoken nearly every language on the planet. We have degrees in finance, engineering, hotel administration and law. We are painters, scientists, entrepreneurs and explorers and the time for sticking our heads in the sand is over. Now is the time to reinvent ourselves. Now is our time to take back medicine.
    Courtesy of