Friday, December 30, 2011

Health Care's New Playbook

It is tough playing man-to-man when coaches on the sideline keep insisting your team plays zone.

Such is it with health care.

For doctors, the man-to-man defense never ends. Stay with them. Glue to them. Move with them. Run with them. Defend against the bounce pass, or the dribble to avoid the admission. Hands up! Watch their waist, ignore the head fake. You shift your coverage to accommodate their needs. One on one, mana-a-mano.

But for the business of medicine, it's all about the zone. Defend the admission basket against as many people as possible with the least number of defenders. Stay in your position. Work it 2-1-2, 2-3, or if you're really adventurous: 1-2-2. Stick to our limited number of defenses using small variations with the same number of people. Keep your hands up so you look bigger than you are! Don't let them near the hospitalization goal! We've seen all their plays and watched all their moves with our electronic record, so let's win this game! If the patients move left, you move left. If the patient moves right, you move right. Anticipate! How hard can it be?

When you only look from the sidelines, everything seems obvious.

But what happens when the patients change tactics? What if the patient's psyche or medical issues don't follow the typical playbook? Will our zone defense apply enough pressure on patients to affect change? Or will it apply too much pressure upon them, causing them to drop out of the game? Who wins then? When the bench is left too limited and the game extends too long, will the exhausted physician defenders be able to convince the coaches that there's a better way to play defense against these admissions?

Every frontline health care professional knows that the health care game is played one patient at a time and on one court at a time. And yet, we see more courts being built and technologic advances being funded as spectators are sold on the illusion that doctors can suddenly play multiple games on multiple courts with multiple patients with an infinite game clock while never dropping the ball. Even now, the storyline remains: we cannot afford to play health care one-on-one.

So the players become confused. They wonder (more than ever) who they're really playing for. The players wonder why they continue to see more money than God spent on the courts, the lights and the corporate skyboxes instead of the critical players themselves. Will our health care game be won by building more courts or by actually playing the game? How many administrative coaches do we need?

Most of all, since its now come down to money versus care, how will we ever put doctors, hospitals and patients on the same team?



Dr Lew said...

All net and no rim.

Well said, Dr. Wes.

Tim Hulsey, MD said...

Unfortunately, physicians are the only ones who seem to care how well the game is played. I.e., how well the patient responds to the treatment plan and recovers. Hospitals might like to put patient care first– at least the nurses– but their time is spent chasing the JCAHO-blah-blah-blah carrot dangled on the Medicare stick. The computer has to be fed! It reminds me of Little Shop of Horrors. "FEED ME!!
There are no rewards for physicians. We are being fouled blatantly and continuously because the referees are on the opposing team! We try to be enthusiastic patient advocates, but the continual beat-downs are wearing us down, just as the other team wants. Doctors have traditionally been strong-willed, independent, and quick to keep unqualified players of the court. The more they wear us away, the easier "providers" will be to control. The less independent we are by becoming employees, the easier we are to control. The more we feed the EMR (read spawn of the devil) the more control they get. Medicine is dying as a profession according to a well-constructed plan to turn it into a technical trade with less requirement for expertise, experience, and clinical judgment. The Obama socialists want to make this country mediocre, and that includes health care. There goal is only to check the full coverage box. What a shame!

Anonymous said...

My stomach turns when a new patient shows up in the ER with CHF. I am terrified that they will be the one who returns every week despite every attempt to prevent this occurrence. All of my patients with a CHF dx are seen once a week for four weeks in the office to avoid readmission. In short, I live in fear of not only CMS with their tracking programs but also a hospital administration determined to get their 1-3% at the end of the year. When the thirty days turns to 60 then 90 days, I am done with this. Not to mention, patients who live out of town who are unable to follow up or go to another ER. This is too much and I can't take much more.

I am in the process of developing a concierge program and just dropping out/giving up. Other docs in my community have been able to find 250-300 patients willing to pay for a private physician. As it stands now, I provide much primary care since medicare patients cannot find a PCP.

Dr. RC said...

Hursey, you loose all credibility when you play the "Obama is a socialist" card. You see, the people at the top- the insurance company CEOs, the hospital chain CEOs, the Big Pharma CEOs, the EMR compnay CEOs-they are driving all this. It is called capitalism. Remember, Greed is Good. And I can promise you this: they ain't votin' for no Obama.
You don't like socialism? Do us all a favor and quit taking Medicare/Medicaid patients. And just a reminder: every major survey to date shows a majority of Americans want to keep Medicare.