Blog | Friday, November 9, 2012

Why the 'suits' are wrong about primary care so often!


Pauline Chen has a wonderful piece in the New York Times, "Challenging Assumptions in the Push for Better Care": "When a colleague of mine announced her retirement recently, she said she was going to miss her patients, but not the pressures of running a practice, nor the plethora of new insurance regulations and initiatives to improve the way doctors run their offices."

Most physicians use the derisive terms "suits" to describe administrators who tell us how to practice. Suits can work in the "C" suite, or insurance companies, or CMS, or even in legislatures or Congress. Suits have grandiose ideas, but they rarely test those ideas.

Suits like to compare our practice to flying an airplane or making widgets. Suits do not really understand the complexity that even the simplest visits entail.

"Where's the proof?" she asked tensely, forgetting for a moment that she was retiring. "Why is it that I can't prescribe a medication without studies to back me up, but we doctors must overhaul our practices without data to show that the changes will actually make a difference?"

Then Dr. Chen links to this blog!

She does a wonderful job of collecting a wide variety of "solutions" and explaining why they do not work.

Suits never seem to understand the unintended consequences (or as my son says – the negative externalities) of all these misguided attempts to "improve practice".

Last July Danielle Ofri, MD, FACP, wrote in this wonderful piece, "Why Would Anyone Choose to Become a Doctor?": "When I close the door to the exam room and it's just the patient and me, with all the bureaucracy safely barricaded outside, the power of human connection becomes palpable. I can't always make my patients feel better, but the opportunity to try cannot be underestimated."

The late Steven Covey in 7 Habits of Highly Effective People emphasized habit #2 Begin with the End in Mind.

Thus, I challenge the Suits to define the end. The end is not increased collections. The end is not "productivity", at least the current why they measure it. The end is not process measures.

What is the goal of health care? We want to improve the quality and quantity of life for our patients. An auxiliary goal is to do that while limiting harm (primum non nocere) and controlling expenditures. Why do we need to control expenditures? We must strive for HVC3 (high-value, cost conscious care) because society does have limited dollars available for health care. We have a limited pie, so we must not hamper the commons by spending too much unnecessarily on any patient. Our current tendencies, encouraged by a dysfunctional payment system, leads to a tragedy of the commons.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.