Wednesday, August 11, 2010

Living the Questions

"Live the questions now. Perhaps then, without hardly noticing, you will live along some distant day into the answers.”

- Rainer Maria Rilke
With the tectonic shifts underway in America's health care delivery model, doctors influence in shaping the forces ahead seems to be dwindling.

It started with the entire health care bill drafted by a team of some undisclosed, very influential academics, lawyers and policy wonks adept at social security and tax laws and was morphed by corporate and hospital interests with huge political and financial influence. Before the legislation was even read, the American Medical Association had stamped their seal of approval, worried that "they'd be eaten if they weren't at the table." As a result, a significant number, no, I'll stick my neck out here and say a majority of doctors, had little to do with shaping health care in America as we will come to know it.

But I would also bet that most of Americans want doctors with their best interests at heart to be integral participants in shaping our new health care system.

So now, as doctors align themselves with a single health system employer so they can beg for a portion of the government's soon-to-be-implemented "bundled" (bungled?) payment scheme to health care systems for episodes of care, how will doctors have any meaningful voice at improving health care for our patients and ourselves?

Enter social media.

I do not think social media, especially health care social media, is the best avenue to interact with patients. It's simply too risky on too many levels. But when interacting with colleagues on a professional level - it might be perfect.

It's fast. It's instantaneous. And most important:

It can influence.

But doctors must get used to creating influence not based on the scientific method as we know it. Doctors must get used to the influence imparted by lightning strikes.

As a simple analogy, Susan Boyle was a lightning strike (though not for medicine, per se). Her plain appearance meant little when it was contrasted with her powerful voice and its influence on the music scene at the time.

To administrators and regulators, doctors have a very plain employee-like appearance but carry powerful ties to their patients and are therefore uniquely situated to create their own lightning strikes in health care.

But doctors do not have time to sit in lengthy meetings planning strategies. Doctors (except a very few of us) have no interest in creating their own blogs. Doctors do not have time to endlessly perseverate on administrative and insurance issues as they try to repair a ruptured spleen.

But doctor are on line. Doctors do have cell phones. Increasingly, those cell phones are smart phones. And doctors can use social media to influence.

Of course, tons of websites are popping up all over promising to do just that for doctors. The New England Journal if Medicine, Sermo, iMedExchange, LinkedIn and a whole host of others - each with their registration process and promise of becoming the perfect Electronic Doctor's Lounge to interact (aka, waste time) with your peers. But these probably aren't going to influence health care policy and procedures in a meaningful way because there's just too many of them out there.

But I DO think doctors understand the need to know what's going on, but want a simple way to do it. Doctors want a simple way to connect and aire their concerns - irrespective of their employer. Doctors should participate in improving their care of patients.

And yes, right now, this minute, none of us has all the answers.

But here's the thought: we can all ask the questions. We can pose the problems we see today that influences our patients' care. We can collaborate and sign up for Twitter to follow our colleagues and maybe, just maybe, "without hardly noticing, we will live along some distant day into the answers."

Lightning strikes and all.



Keith said...


I think doctors can have immense influence on the health care system still. Unfortunately many have chosen not to get involved (the I dont't have enough time for this syndrome). Physicians are fragmented in their political representation due to the nature of competing specialties forced to scramble for the crumbs left over after hospitals, insurance companies and pharmaceutical manufacturers take their significant slices. Each of these industries are united by a powerful advocay group that pours huge resources into lobbying. Physicains are united by the AMA which the majority of docs don't even belong to.

What I see is more and more of physicians beocoming co- conspirators with these industries to their own personal gain, whether it is the department chair that does the bidding of hospital administration or the physician on the speaker circuit pumping up the benefit of that new pharmaceutical. It now appears that the path to wealth in medicine is in becoming attached to these other powerful health care players and working for their benefit vs those of their collegues or for the general benefit of medicine. Wealthy docs no longer will be the ones taking care of patients; they will be the ones involved in hospital adminitration or working for pharmaceutical companies.

Until we unite and throw out the physician co-conspirators, we will continue to see the physicians power and influence in this system wane.

DrWes said...

Keith -

What I see is more and more of physicians beocoming co- conspirators with these industries to their own personal gain, whether it is the department chair that does the bidding of hospital administration or the physician on the speaker circuit pumping up the benefit of that new pharmaceutical.

The alignment of physician groups with corporate hospital systems naturally lends itself to such "co-conspiratory" practices that place business interests before the patients' interests. When lower government payments force rationing of monies between care-givers, look for the politically-connected to get their piece first.

That's how business works. To do otherwise won't be viewed positively by your new employer.

This reality is just one of the many inevitable unintended consequences we'll soon see thanks to our new health care reform "corporate physician alignment" imposed by the PPACA law.

Gary M. Levin said...

Well, Dr Wes, I agree with you of course, I am one of those physicians (gag---providers). You are correct, social networking has become 'it' and crowd-sourcing ( a new one to me )exponentially levels the playing field. I now have most of my blog posts linked to twitter and linkedin, facebook and the rest of to let my 'little' voice be heard. The cacaphony is rising, however the downside is that the ambient noise level is rising as fast or faster than our message. It threatens to overwhelm the common patient who may just turn it all off, roll over, and go with the flow. (as much of it has already done in America.

jimbino said...

My schadenfreude tells me that American doctors deserve the crap they're being dealt.

For years they have had the chance to rationalize healthcare by such simple measures as:

1. Taking all comers and treating them the same (no wallet and no insurance biopsies, MFN status for all)

2. Publishing all prices on the web.

3. Unbundling services and offering discounts for those who pay cash, etc.

Doctors have a hell of a lot to learn from Walmart, which has long since observed the rules above. At this sad point, the best thing that could happen to doctors is that they become employees of Walmart clinics and hospitals.

I once considered a career in medicine, but have since come to loathe the medical industry--a result of experiences like spending an hour on the phone with MD Anderson just to find what they charge for a colonoscopy.

I would prefer to bury Amerikan medicine and start over again. In the meantime, I'd like you physicians who post here to justify your price discrimination, your hiding of charges for services and you reluctance to offer simple things like discounts for cash up front.