Physicians need to embrace change to fix heathcare

Several interesting facts crossed my computer screen recently.  The first was a Tweet by American Medical News that the first CT scan was performed on August 25th 1973.  The second focused on the large number of practicing physicians who suffer from burnout, and the third was an article, which cited a talk given by Vinod Khosia in which he is quoted as saying “80 percent of doctors could be replaced by machines.”

I believe that technology has been a major factor in improving our capability to diagnose and treat our patients. In terms of physician satisfaction, has technology been a net positive or negative?  As one scans responses of physicians commenting on electronic medical records, telemedicine and social media it appears many believe they are the enemy rather than an ally.

Clinical practice is hard, demanding, stressful, and it has changed significantly over the past 40 years.  As a reminder, in 1966 there were 5 antibiotics, no CT scans, MRI’s or ultrasound machines.  ICU’s and coronary care units were not routinely found in many hospitals.   People with heart attacks were hospitalized for 18 days and one of the most common surgical procedures was a vagatomy and pyloroplasty for peptic ulcer disease that is now treated with over the counter medication. Insurance companies did not cover routine outpatient care, most physicians were in solo practice and almost nobody thought doctors were over paid.   Nobody questioned the quality of care or its cost.

Fast-forward 40 years — there are now at least 11 classes of antibiotics with multiple drugs in each class.  There are anti-viral and antifungal drugs.  Heart attack patients may go home in less than three days.  The average length of stay for a patient in many hospitals is less than 4 days.  Much elective surgery is admitted and discharged in less than a day.  As a means of improving quality, efficiency and cost many hospitals have begun hiring physicians and with the more Accountable Care Organizations (ACO) it is possible that the solo practitioner will become an endangered species.

Just this year nine subspecialty boards representing 374,000 physicians published a document recommending 45 tests that should not be done on a routine basis.  Last year there was a furor over the frequency of mammograms and pap smears as well as PSA test for men.  Many of our assumptions and beliefs about what is necessary are changing.

Our healthcare delivery system is broken.  Everyone complains about the cost of care.  The quality of care is being questioned and doctors and hospitals are now subject to a myriad of report cards.

Doctors complain about paper work, computers, insurance companies, to little time to spend with each patient or patients who are demanding and rarely listen to their advice.  Patients complain about disinterested or uncaring physicians, insurance company regulations, poor service or quality and lack of communication. Is it any wonder that physicians might feel burnt out and under siege?

To address the problems that plague our healthcare delivery system and improve burnout physicians will need to embrace a different kind of change.  During the 20th century change came in the form of new medications, new tools for diagnosis, (MRIs, CT scans, ultrasounds) and new machinery (ventilators, heart bypass, dialysis and robots for surgery).    All of these changes required the active involvement of the physician to either write the prescription order the test or perform the procedure.

In his recent book “The Creative Destruction of Medicine” Eric Topol talks about the timing of the “big six major digital advances of the last 40 years, (cell phone, personal computer, Internet, digital devices, DNA sequencing and social networks) that have set up the great inflection of medicine.”  These advances have changed the landscape with regard to the doctor patient relationship and the potential interactions that can occur.

According to the Centers for Disease Control and Prevention, 75 percent of our healthcare expenditures go for the management of chronic care. Just as DNA sequencing will allow us to customize treatment so must we strategically think of alternative modes of patient management to get away from the “routine” doctor visit?  Can we change reimbursement models so physicians or others can be paid to utilize new means of communication and management?  Accountable Care Organizations are in their early stage of development but I firmly believe physicians willing to aggressively recommend home monitoring devices, disease specific social networking sites, alternative means of communication including secure e-mail and telemedicine can go a long way toward improving the quality of care for the patient and the physicians quality of life

Medicine is challenging ever changing and dynamic.   In my experience many physicians enter practice and assume they will do the same thing for their entire career.  No wonder there is burnout.  Physicians need to embrace change and get on with the “creative destruction of medicine.”

Eugene Spiritus is President and Chief Medical Officer of OMyMeds!

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  • Steven Reznick

    As a 63 year old general internist I embrace change. I enjoy communicating by cell phone, email. test message . I love the technology I have at my fingertips for diagnostic and therapeutic indications. I disdain the use of technology to replace patient contact. I disdain the use of technology as a substitute for a thorough and comprehensive history and examination. I disdain change and technology when it adds senseless bureaucratic layers of rules and regulations to our offices and hospitals committing dollars to non medical personnel instead of health care personnel. I disdain the lack of communication and willingness of practitioners to talk to each other about mutual patients when the technology makes it so easy and everyone so accessible. Doctors burnout because insurance companies and naive but well meaning employers have kidnapped the practice of medicine and are holding the patients and caregivers hostage while using technology to attempt to replace all that was human and personal and comforting in health care. One of the key reasons I entered medicine because it is a profession of life long learning and change for the betterment of patient care. Hospital administration, health care consultants and attorneys, pharmaceutical companies and most important health insurance companies see it as an everlasting source of profit and little more. They create the bureaucracy and impediments to care and use of technology to enhance our clinical skills. That’s why docs burn out.

    • Eugene Spiritus

      I am really focused on using inexpensive technology, electronic scales, blood pressure cuff, pulse oximetry, and telepresence for managing patients with chronic disease. The physician-patient interaction is important but much can be gained by getting patients more engaged through technology.

      • Steven Reznick

        Been using that for years. It doesnt replace giving patients sufficient time to talk and express themselves while the physician listens. Technology and change are meant to assist us and make our work easier to perform and more productive. We all expected research to change the way we practice. We expected advances in science to change our practice patterns. We didnt expect insurance company pre authorizations for referrals, medications, outpatient and inpatient procedures and admissions. we didnt expect or want different formularies and tiers of medication choices in an outpatient setting and inpatient setting, We didnt expect that after struggling to find the right choice and dosage of medication for a complicated emotionally ill patient to have to change all the medications due to formulary variations when he enters the hospital for a procuedure We didnt expect having the best practitioner for the problem not be on the plan. We didnt expect to find more people in white coats carrying clip boards running around the hospital trying to make sure practitioners and nurses follow Joint Commission decrees which add little or nothing to patient care or safety instead of spending the available funding on patient care. I can go on and on about how individuals with an MD or PhD or JD after their name who no longer or never cared for anyone ill are making the rules and suggestions despite having little or no experience with trying to care for an aging and more chronically ill population in shorter visits each year

        • Deep Ramachandran

          Amen, brother!

      • southerndoc1

        “I am really focused on using inexpensive technology, electronic scales, blood pressure cuff, pulse oximetry, and telepresence for managing patients with chronic disease.”

        I have no problem with any of those.But, for some reason, when you say I need to “embrace” them, I think that means you want me to stay late at the office to review the data, call the patient, and make treatment decisions (all for free).

  • Margalit Gur-Arie

    Some folks “firmly believe” one thing, others “firmly believe” another thing. I’m not sure what “Our health care delivery system is broken” really means, and I am not sure that the delivery system is the one that’s broken.
    Either way we need more than firm beliefs before we creatively destroy anything, broken or not. Neither CT scans nor antibiotics were adopted based on somebody’s firm belief, and I wonder what medicine would look like today if firm beliefs of manufacturers were enough to effect change.

    • Eugene Spiritus

      A system that excludes millions of americans, costs more than any other industrialized nation and whose quality has been called into question, is in my estimation broken

      • Margalit Gur-Arie

        I would say that this has to do more with the financing system than with the delivery system. Nobody is calling the quality of care available to wealthy individuals into question…

  • rswmd

    “In my experience many physicians enter practice and assume they will do the same thing for their entire career.”

    Strange. In 30 years in medicine, I’ve never met a physician who assumed that.

    Every doc I know thrives on change. What is burning them out (and I know lots like that) is the inexorable, UNCHANGING movement towards always more bureaucracy, more administrative tasks, more time wasted in non-patient care busy work, etc.

  • Dike Drummond MD

    Stop Embracing and Start Driving – is a motto I recommend for doctors. Rather than passively wrapping your arms around whatever comes down from our hospital, group administration, insurance company or the government … either play a role in shaping that organizational change or step out and play a role in shaping your own personal future.

    Healthcare is not broken. The system is what it is. The question for each of us is not “how do I embrace it” … the question is “what is my response to this as one of my options”? You have much more control over your day to day practice than you realize. Time to take on a leadership role in your own practice or organization and shape the change, influence the debate, play a role in designing the systems.

    My two cents,

    Dike Drummond MD

  • buzzkillersmith

    Embracing change is a euphemism for embracing continuing abuse, but the burnout article was kinda interesting. The factor that best predicts it is being ion the front lines. Amen to that. Here’s a healthcare change that I would like to embrace: early retirement.

  • Lily Ann Hainline

    This article was quite informative and embraces the idea that over the last 40 years much change in the medical field has evolved. As a layman in this industry, I have recently found that taking a more aggressive position in my own medical care has been the only way to get results. According to some of my friends, they too, have been amazed at the lack of communication skills when dealing with their doctors. It makes sense to have the best ways for doctors to communicate with their patients for the best medical results.

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