Putting the Health Back in Health Care

There is a massive amount of over treatment, and variation in that treatment. There are many different electronic health re- cords (EHRs) for notes, prescriptions, and billing.

The second problem is that doctors see clinical pathways and “best practice protocols” as a straightjacket that limits their treatment options, when, in fact, they’re very effective at establishing best practices for different treatment scenarios—the best time to put in a stent, for example—which lessens mistakes.

The data is clear that establishing best practice does work, while still allowing for human intuition. I’m talking about the underutilized ultra-basics: repurposing already existing drugs, vigilant hand washing, use of checklists.

The absurd simplicity of a checklist paired with the enormous impact of life-saving…it should be a no-brainer! But doctors often don’t like checklists. It often has to do with ego.

You can’t just say to a highly educated, experienced physician, “Do it my way.”They need to be shown the data that proves the simple things work.

Meanwhile, doctors are overworked, going from patient to patient all day. And they are long days. They get hungry, tired, irritable, and understandably taxed—even annoyed at the expectation that every patient should be their primary focus.

Doctors are only human. They, too, want to go home to their families at the end of the day. They need sleep.

This professional and emotional system-wide fatigue ends up translating into highly regarded doctors not paying close attention to the living, breathing people sitting right there in front of them in the exam room.

Simple, first-hand observation of a patient—a whole patient—can lead to the most effective “prescriptions” for health, which often don’t require medication as we’ve come to know it. But lapses in basic observation can lead to misdiagnoses of the worst kind.

What I’m interested in is how we release physicians from the structural and administrative minutiae and bullshit so they can be freed up to apply their human intuition to individual patient scenarios, and then pair that intuition with their ex- tensive, very specialized knowledge base.

It’s the interplay and information exchange—the mutualism between these two types of knowing—that will result in the best doctor-patient relations, the highest quality information sharing, the most valuable knowledge building for all parties, the most accurate diagnoses and effective treatments, dramatically increased re- covery rates, a much more enjoyable health care experience for patients, and greater professional gratification for doctors—not to mention the “softer” rewards of making a positive difference all around.

As it stands, physicians are practicing under a huge cloud of uncertainty. Largely, they’re selling an illusion of control. And we, to our detriment, buy right into it. Our health system is basically operating in the Dark Ages.

What simple solution should we implement to make our health care system function better?

The most obvious is to change the way doctors get paid. High quality systems like the Mayo Clinic pay their doctors salaries. This dramatically changes how medicine is practiced.

When doctors are compensated in a “fee-for-service” structure, they’re forced to think like businessmen and have to consider which procedure will lose money and which will make money. This is a terrible incentive for someone entrusted with the care of others’ wellbeing.