Medical students can rebuild our broken system from within

As a medical student seeking to learn the principles of entrepreneurship, I have found Steve Blank’s insight to be a great guide and resource. His Harvard Business Review article, entitled “Why the Lean Start-Up Changes Everything,” was my first exposure to the idea of customer discovery.

The idea of customer discovery is a simple practice — listening intimately to multiple customers’ needs and pain points and using it to inform a specific, tailored solution. Mr. Blank relieves some apparent pressure on the entrepreneur because generating viable ideas does not require prodigious smarts or talents — merely the willingness to “get out of the building” to talk to as many potential customers as possible with tenacious empathy.

The word “empathy” serves as a buzzword that brings my mind back to my medical training. And then it strikes me: The general clinical year that every medical student embarks on offers the best customer discovery opportunity in all of health care.

No health care professional gets out of the building more than the medical student, whose general clinical year is structured such that they rotate in 10 different disciplines (e.g. surgery, medicine, pediatrics, etc.) and on up to 29 different services (e.g. trauma surgery, thoracic surgery, anesthesia, etc.). We are essentially “homeless” during this time. This universal medical education component delivers intense, diverse, and intimate encounters with potential customers of all kinds, including patients, providers, and health systems.

If I take Mr. Blank’s plea more metaphorically, I also sense he instructs entrepreneurs to remove themselves from their habitual thought patterns and daily workflow to truly understand and wrestle with their customers’ pain points. As medical students, we generally lack a firmly entrenched status quo in our thinking or work. We are blissfully naïve, truly listening to and learning from our patients and colleagues with minimal bias or conceit.

Given these capacities, medical students may be better available to “get out of their heads” than those people further along in training, who routinely attend to a narrow patient population as part of a consistent team. We have enormous potential to identify and define health care opportunities for change if only we are encouraged and equipped to do so.

Undergraduate medical education must evolve to foster innovative thinking in addition to medical expertise. The general clinical year affords the ideal environment in which to cultivate innovative thinking in preparation for the long road of training ahead. By unlocking medical students’ potential to stimulate change, we can empower future innovative health care leaders to significantly and meaningfully influence the creative destruction of our health care system that is happening everyday around us. We can be the ones to rebuild our broken system from within. Our patients and our society will be better served because of it.

Jonathan O’Donnell is a medical student and can be reached on Twitter @jonodoc.

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  • NewMexicoRam

    Very boisterous talk. Do you have a family you are supporting? But, good luck.

    • Jonodoc

      @NewMexicoRam:disqus: In fact, I do have a family that I will be supporting (once I finish medical school and begin to earn income). I’d be interested to hear more about what you are implying when you ask that question.

      • NewMexicoRam

        Things change when the money has to be there to support the family. Ideals are nice, and some even eventually are implemented, but money pays the bills. In the 25 years I’ve been out of residency, I have to spend less time with the patient so I can pay the bills. Now if I can just figure out how to get the EHR to function faster so I can go home earlier for my kids.

        • Jonodoc

          Totally – EHRs have complicated things dramatically. I’m helping with a startup called EyeScribes that hopes to relieve that very issue. It will be piloted at 3 sites this month in North Carolina, so it’s on its way!

          • SteveCaley

            WHY did EHR’s complicate things so dramatically? They started out with the best of intentions. Show how your ideas can avoid that pitfall.

          • DeceasedMD1

            Do you think outsourcing is an innovative good idea? Think of customer service outsourced to india? Is it efficient and more to the point ethical in the end?

          • guest

            Right. With outsourcing, is the customer ever happy with anything other than the lower price?

          • DeceasedMD1

            Not even! No one could pay me enough for that aggravation. You know where this is going, corp med making it cheaper and cheaper at a great cost to medicine. Already the medical record has been destroyed. Let’s just destroy it a little more…

        • buzzkillerjsmith

          Helping with a startup! See, see, did I call it? Admit it, I called it!

          An MBA by any other name….

  • SteveCaley

    Yes, and no. The principles of lean startup are intelligent, and worthwhile understanding by any clever person. Whether they can be injected into the healthcare environment is not at all proven.

    I doubt it.

    Much of what passes for innovation and entrepreneurship in medicine is retread instrumentalism. The reason that startups and entrepreneurship are such darlings in business is their immaturity – they have not been saddled by the crippling yoke of Mature American Business Management, which is 100 years old and sadly decrepit. It is the paradox of Modernism – Modernism is now the Dead Hand it once rebelled against. The Dead Hand of Mr. Flexner hovers over all the medical schools, even still.

    However; the moment we invent a new species, count me in for innovation. We’re stuck with the same old human design.

    I’m having a hard time parsing any sense out of the following sentence: “By unlocking medical students’ potential to stimulate change, we can empower future innovative health care leaders to significantly and meaningfully influence the creative destruction of our health care system that is happening everyday around us.”
    All I can get out of the jargon is that new students should change what is old, and whatever a healthcare leader is, they should creatively destroy our healthcare system. I don’t like the “creatively destroy” concept – there’s too much “destroy” in it, and destroying what you don’t understand is the hallmark of civilization in decline, not in creation. Been there, done that – got the Little Red Book. Great Leaps Forward have a history; rarely is it good. Smashing is jolly good fun, but then what?

    • buzzkillerjsmith

      Diagnosis and treatment is hard, really hard. Sometimes you even have to do it at night.

      It is much much easier to talking about the ever-rosier future to people who pay good money to hear it. And if you want that gig it’s better to start young.

      I predict an MBA for youngdoc here.

      • Jonodoc

        Hi @buzzkillerjsmith:disqus, I agree that diagnosis and treatment are really hard. But fortunately for those of who will be practicing in the medical field in the next 10-20 years, implantable technology that passively and continuously monitors patients and cloud computing like IBM Watson will make it much, much easier. Especially at night. The physician’s role is changing, and it is up to those trainees who are younger and less inured in the status quo to develop the skill set to shape the future of their profession.

        As for the MBA, I don’t believe it is in my near future, but I know plenty who back for it at a later date.

        • buzzkillerjsmith

          Your thoughts on this are rubbish, as you might or might not discover at some point.

          Overmonitoring makes diagnosis and treatment harder, not easier. The engineers call it noise.

          Skill set. Let’s dialogue about shaping the future in a synergistic way. It’s win-win and six sigma with a jigger of big data– all shaping the future.

          Diagnosis is about thinking, not stuffing your brain with crap. You got a lot to learn, young guy. But first you have to somehow get rid of that brainworm.

          You can fool some of them, but not many of them here.

          • Jonodoc

            Hi buzzkillerjsmith, I could not agree more that “Diagnosis is about thinking, not stuffing your brain with crap.” Currently, our undergraduate medical eduction system fails us in this regard for medical school has been all about “stuffing our brain” at the expense of our thinking.

            I’m not sure what you are saying in your Skill Set paragraph. Can you elaborate more? With whom do you see us synergizing?

            I’m curious to hear what your current and historical roles are in the health care system.

            I’m not trying to fool anyone here.

          • buzzkillersmith

            Cripes!

          • SteveCaley

            With all due respect, medical school is a process of training a person to be a physician. Even by the end of the fourth year, these young doctors are still very new.

            How can you tell, during the process – especially when the clinical years have just begun – what is relevant and irrelevant, what is inefficient and what is efficient? That’s a long sorting-out process. It’s far better for you to bring out and discuss specifics and their relevance, rather than to swish the brush during the third year of medical school.

            One of the CRITICAL topics doctors must be expert at is observational taxonomy and meronomy. The words are unfamiliar; the principles are VERY familiar. That is the sort of thing one learns by seeing patients during the clinical years. Developing one’s expertise in these areas, among many others, is what one should do in the third year. It is harmless to point out inconsistencies, and you are probably onto something in your observations of them. Yes, medical school is a time to see and plan for systems; but the learning is still inchoate.

          • Jonodoc

            @SteveCaley:disqus – Medical school should always be a process to train a person to become a physician, but I sense that the “physician” is changing, and thus medical education should change as well to equip and position physicians to continue to be leaders as digital health technologies work to permeate health system and patient activities. Soon, the days will be gone when we need 1-2 years to memorize the breadth of information that we absorb in the pre-clinical years – yes, we need to KNOW and UNDERSTAND microbiology, pharmacology, pathology, etc, but there are an increasing number of technologies that support us in this endeavor, freeing physicians from that exercise in memorization to return to true patient care, listening to their patients’ and their health systems’ needs and LEADING improvements in health care, and not merely receiving what outsiders think are the needs, pain points, and solutions. The physician of tomorrow will be different from the physician of today (and from the physician of yesterday) – medical education needs to recognize this and equip medical students with better thinking skills, and not just the regurgitation of all the information that is already stored in the Internet (and IBM Watson). Let technology store the information; let physicians work on improving the utilization and delivery of that information, which a computer will never get right humanely and compassionately. We need to learn to work with technology, not against it.

            I could not agree more that the clinical year of medical school should be about learning what is relevant/irrelevant, efficient/inefficient – but it is important that medical students learn to think about WHY these things are the way they are – and to feel safe asking these questions – alongside and in collaboration with WHAT the things are to begin with. They are not mutually exclusive; they are mutually beneficial.

          • SteveCaley

            Several points in reply, John O’ –
            I think you would find it incredibly insightful to read Abraham Flexner’s report from 1910, for the purpose of understanding what reforms were implemented,
            then relevant but now obsolete. Without understanding the origins of the current system, it’s hard for a person to understand what was well-innovated in intelligent progress over the years, and what was simply arrested in
            convention due to following Flexner’s ideas in a formulaic, mindless manner. I think Flexner’s report will inspire you.
            The deeper criticism I have for some of your thoughts is from my concern about Technopoly (as Neil Postman calls it) or Technopathy (as I
            call it.) The information on Watson, its “truths,” arise from scientific observations that are canonically reviewed and accepted by Academic Scientific Authority. Much of the data is founded on an increasingly weak and biased research environment here in the US. Research funded by drug companies are usually unbiased, but not always we hope; and the authors are never disinterested. Research in medical journals is often laughed at by the basic scientists, – how frequently great new innovations are proposed and then refuted.
            The problem with turning to Watson or the
            Internet as though it contains Biblical authority, is to give the people responsible for creating and publishing the information extraordinary power.
            The medical system is rapidly gravitating to an oligarchic structure, where the few Educated
            dictate the rules, and the Followers obey.
            That is different from the concept of disseminated cognition. In general, the last century or two has shown that centralization of authority and power leads to unresponsiveness – a ‘one-size-fits-all’ approach echoed in the “Best Practices” movement. There’s not enough space here to explain why chaotic systems cannot work under centralized control. They don’t tend to.
            Technology must be kept in-harness to prevent the systems from going awry. I agree with Steven Hawking and Joe Weizenbaum on this. Technology makes for a pleasant servant, but a terrible master.
            One of the VERY BEST CHALLENGES that medical students can make is why the
            cycle of memorization and machine testing is still used; and how teaching can be humanized, not computerized. After all, multiple-choice testing is the technologically most efficient way to rank people, notwithstanding its mediocrity in making people think.
            And the more standardization we permit, the more we approach mindless mediocrity, not intelligent creativity. There’s a challenge
            for you.

            But without knowing how it’s all connected,
            careless change will accelerate Technopathy, not prevent it. It’s all too easy to get fooled, and find you’ve been fighting for the wrong side.
            Many of the awful things that have happened to medicine have happened with the best and noblest intentions. The medicine of today is far less efficient and effective than the medicine of 20 years ago in many instances, in spite of technological and scientific advances in the underpinnings of the fields that support medicine.
            It may be too late to change the medicine of 20 years from now, in 2035. By then, it’s entirely possible that Mexico will have superior public standard medical care than the United States. We are going in different directions. I suspect we will be about on-par with Turkey; not as good as Canada or Britain; and a little behind Mexico. That is the real and palpable danger. To change it, you need to find out what’s causing it.

        • guest

          Speaking not as a doctor, but as a patient, I have to say I am finding it difficult to muster up enthusiasm for a future medical system in which technology is implanted in me for the purposes of monitoring me and uploading my information to “the cloud.”

          If this is what the current generation of entrepreneurs is coming up with, I say maybe we should be a little less encouraging of entrepreneurship in medicine and maybe a little bit more encouraging of good old fashioned doctoring.

          • Jonodoc

            Thank you, guest, for sharing your thoughts! I’m not sure there is much to muster up enthusiasm for at this time in our medical system but I offered that scenario implantable + cloud computing as one potential future; entrepreneurs are working on lots of different solutions. It is up to empowered patients like yourself to voice your concerns with scenarios like that one as well as suggest patient-centered solutions. I hope you will!

            I hope my citing that example does not distract from the heart of my piece – that medical students have a role to play in reshaping our health delivery system, and that the future of health delivery innovators is being shaped today in an undergraduate medical education system that largely disregards innovative thinking.

          • guest

            Actually, I am a doctor, too. And the trouble with my speaking up with concerns about the scenario above is that I then am labeled “negative” or “a luddite,” and the presumption is that I’m resistant to change, as opposed to seeing real issues for our patients with the specific changes being proposed, and speaking up about them forthrightly.

          • Jonodoc

            Thank you for speaking up as you did. Again, it is but one example.

            I wonder what you think about the message behind my piece?

          • guest

            The message behind your piece appears to be that medical students are uniquely qualified to change our healthcare system. I am sure that they are. The real question is whether they are qualified to change our healthcare system in POSITIVE ways that will benefit our patients. In order to assess your ability to do that, I think we would all have to see more specific examples of innovations you would suggest.

            If you can’t suggest specific innovations, you’re not an innovator.

          • Jonodoc

            Good point – and I think you reinforced my own message when you say, “if you can’t think of specific innovations, than you’re not an innovator.” UME fails to encourage innovative thinking that could lead to specific innovations.

            I have several ideas I am pursuing right now (EyeScribes is one of them) – I don’t think this is the forum to distract from my piece with specifics. I am happy to engage outside of KevinMD if you would like.

          • guest

            I honestly think that true innovation can only occur when you are master of your craft. In medicine, this takes a long time. Of course, someone young and enthusiastic can come up with all sorts of gee-whiz ideas that in the end are not very practical, because they are not based on a deep understanding of how medicine is best practiced.

          • Jonodoc

            There are numerous examples, both within and outside of health care, where people with no experience in an industry make a large impact on it. Deep understand is preferred, but not required.

            One such recent example is the car mechanic who created one solution to improve baby deliveries: http://www.nytimes.com/2013/11/14/health/new-tool-to-ease-difficult-births-a-plastic-bag.html?hp&_r=2&.

          • SteveCaley

            Mike Henderson expressed similar opinions on the apparent generational associations of the technology and change advocates.

            There are several principles in the technological movement, and the old school of Modernism, that directly contradict the traditional methods and ethics of medical practice.

            WHAT CAN BE DONE, MUST BE DONE.

            that dictum makes for bad, useless and expensive medical care. The degree to which this concept has intruded into medical care is proportionate to the amount of “inefficiency” in the system.
            It is easy to come to the forefront of anything, saying that there’s been a lack of good, modern ideas in implementation; and that a scientific and rational approach to things will lead to revolutionary benefit.
            Here is where the generational element may play a key – to me, the Old Guard, that sounds like Trotskyism.

            I think that homeopathy is rather by the wayside by now – increasing the amount of what is killing healthcare, the old Modernism from a century ago, will not cure, but kill the patient.

          • buzzkillersmith

            Flying cars, going to distant galaxies, automatic showers that clean you in seconds, TVs linked to your eyeballs, implanted technology zapping you when you eat a french fry, electronic health records.

    • Jonodoc

      Hi @SteveCaley:disqus, you’re right about the dripping jargon in that sentence, but I’m glad it caught your attention. Perhaps its my naiveté, but I sense that we are undergoing a powerful change akin to a “destruction” as patients (rightfully) acquire more and more control/autonomy regarding their health. The physician’s role is changing, and I am arguing that medical students must be enabled by the undergraduate medical education system to begin to “think differently” and to, as Gandhi suggests, be the change that the health care system wishes to see in this world. As someone about to enter the work force in the physician role, I hope to be among those MDs who lead this change/transformation/destruction and not to be an observer as my profession is molded by business-types and designers/developers who don’t fully understand health care’s pain points. I hope that every medical student, both those in school now and those who enter the system in the future. can feel empowered and equipped to lead. The future of our health care system is intimately tied to how effectively we do – or do not – enable our trainees to play a part in this process and take charge of it.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Nice… I completely agree, with a small caveat.
        Perhaps you would consider being the change you wish to see in the world, instead of deferring to the change the “health care system” wishes to see in the world, because the latter is absolutely not what people want to see, and there will be a high price to pay for your profession if you align yourself with anyone but your patients.

        • Jonodoc

          @MargalitGurArie:disqus, I love it: be the change you that your patients wish to experience in the world.

      • SteveCaley

        Be very cautious when playing with systems that other people’s lives depend on. Before you continue recklessly along an unwise path, I recommend you familiarize yourself with the Dà yuè jìn, the Great Leap Forward of China. It was a completely scientific, arduously planned and carefully orchestrated “creative destruction” of Chinese agriculture to give it the Great Leap Forward into modernism. It was backed by MILLIONS of intelligent, enthusiastic, dedicated, assured modern Chinese. It was brilliant – an excellent conversion of Marxist principles into Mao Thought. Smashing.

        “Estimates of the subsequent death toll by demographic specialists ranged from 18 million to 32.5 million. Historian Frank Dikötter asserts that “coercion, terror, and systematic violence were the very foundation of the Great Leap Forward” and it “motivated one of the most deadly mass killings of human history.” (Wikipedia)

        I assure you, it was NEVER intended to be harmful – it just turned out that way during implementation. Sorry.

        Show that you are familiar with Da yue jin, and Eternal Fascism: Fourteen Ways of Looking at a Blackshirt, by Umberto Eco, writing in New York Review of Books, 22 June 1995. He said, “Ur-Fascism can come back under the most innocent of disguises. Our duty is to uncover it and to point our finger at any of its new instances — every day, in every part of the world.” Your expressions and writing style, postulates and vague futurism sound awfully totalitarian, I’m certain. It makes me very uneasy. Implanting observation devices to “empower” patients is raw Newspeak, and is grotesque fascism.
        Don’t take my word for it. Read Joe Weizenbaum’s “Computer Power and Human Reason.” He was the computer programmer who wrote ELIZA – the intellectual parent of these “deep natural thought” projects. He wrote a brilliant chapter about the imperialism of instrumental rationalism.
        How many millions of lives might be lost because of the self-assurance and self-confidence of the “new thinkers?” How can we say “The treatment was a success, but the patient died.”
        Forgiving yourself for these sorts of things is easy. And those millions of dead – well, they’re dead.

    • DeceasedMD1

      Reading your post reminds me so much of the old rock group the Who. Destroying and smashing all these beautiful instruments after every concert. I think it was jolly good fun for them.
      I like your “hallmark of civilization in decline”comment. We are sort of at the end of Roman times.

  • KoharJones

    I completely agree that third year of medical school is a uniquely powerful opportunity to understand what works and what doesn’t work in medicine, the many moving pieces of our not-quite-system. If we teach medical students to think critically about systems, systems change, and the health care system, then third year is a unique learning experience. We don’t do this now. In my experience as a medical educator, I have found that the great majority of students are more focused on learning what they need to do to take care of individual patients safely rather than thinking about systems and how they can help to shape the systems in which they work. Instead the systems shape them.

    • Jonodoc

      Hi @KoharJones:disqus, I’m totally on board! I am not proposing or implying that we need to focus less on individual patient care but rather to wake up in the midst of patient care to note the inefficiencies, the opportunities, the pain points. We can help to reshape the system from within.

      • guest

        I think it would help you make your points more effectively if you could provide specific examples rather than generalities and jargon. For example, what sorts of inefficiencies are you seeing in our current system?

        So far the only thing close to a specific example I have seen is what appears to be an alarming suggestion that patient care at night could be handled not by a live on-call doctor, but by implantable technology and computerized decision-making.

        • Jonodoc

          Hi @disqus_8XTL2Drwiw:disqus – good thoughts. I did not include the countless inefficiencies because that is not the crux of my piece. Plus, then many people wouldn’t read it because it would be too long!

          Some can focus on patients (e.g. how can we help with disease prevention, medication adherence, scheduling, payments, health literacy, psychosocial support for chronic disease, etc.), providers (physicians spend 30-50% of their workday documenting on computers – time they could spend seeing patients, undergraduate medical education, etc), payers (cost transparency, benefits to patients), etc.

          More importantly, what are some of the issues that you see as most prominent?

          • guest

            In my opinion, the most prominent, and the most overlooked issue is that doctors are not given enough time with their patients to get to know them as people, and so they cannot really minister to them in any meaningful way. I really don’t see too many medical students paying attention to that, though, and the cynical interpretation would be that optimizing the healthcare system so that patients get what they want (thoughtful care from a non-rushed doctor who knows who they are) is just not an exciting enough project to attract attention from administrators or from medical student “innovators.”

          • Jonodoc

            You and @NewMexicoRam:disqus agree! This is clearly a large problem. I’ll refer you to exciting projects using Google Glass and medical scribes – EyeScribes is one startup I am helping make a large impact on the 30-50% of each workday that physicians spend/day documenting and billing. At least one medical student “innovator” is interested in this space, and I know many others in my school are eager to help, if only they were encouraged and enabled to think and talk about these things.

          • guest

            OK, I googled your start up and have my patient hat back on. I am not even sure where I would begin with my concerns, as a patient, with having my encounters with my doctor videotaped, streamed to a remote location, and viewed by a complete stranger for the purposes of documenting the encounter. I think the most serious one would be complete lack of real-time interaction between the doctor and the scribe, which would almost certainly adversely affect documentation quality, unless the goal is just to produce one of those meaningless EMR chart notes that don’t tell anyone anything relevant about the patient.

            Has your company done any sort of market research to assess patient reaction to this product:?

          • Jonodoc

            Glad you Googled it! This is one of the specific innovations you asked to learn more about.

            If you search “Patients Don’t Mind If the Doc Wears Google Glass”, you will see findings from another company in this area. Glass is a very new technology and we are learning day-by-day, staying focused on optimizing and improving the doctor-patient relationship with this tech.

          • guest

            I would be interested to know more about that patient survey. Were the patients asked just prior to their physician encounter, when they were likely feeling anxious, and wanting to be cooperative? Or did they participate in a focus group or a market survey?

          • Jonodoc

            Thank you for your engagement on this issue but I think this is something better discussed outside of this forum. I would like to keep this article focused on medical student innovation.

          • guest

            Oh, sorry, by discussing your innovation, I thought we were in fact focusing on medical student innovation.

          • NewMexicoRam

            I tried the Google glass, and as I have monovision with Lasik, the screen up in the corner was doubled–difficult to read, to say the least. Our company still wants to try it.

          • NewMexicoRam

            I forgot to add, the company we are looking at uses real-time scribes, who can interact with questions when needed. You may know which company I’m speaking about. They say it only takes 4 more patients per day to pay for it and most doctors average 6 more patients and go home earlier.

          • Ed

            No, never, absolutely not! No scribe or electronic video recording, period. The near sacred patient physician relationship and the confidentiality that we all understood as one of the bedrocks of medical ethics is being sacrificed for expediency and profit. There has to be a better way!

          • SteveCaley

            Thank you! The general attitudes towards patients in this “new way of thinking” are repulsive. The argument is firmly in the hands of those who have absolutely no idea what they’re talking about.

            Please look very carefully of what gets called the
            Electronic Medical Record. It is “supposed” to be a document which enables physicians to work better, faster and more efficiently. I have seen very little, if any, praise from physicians for the EMR EXCEPT TO THE DEGREE THAT it gives them more time in the patient encounter. The jargon about “efficiency” is vapid and calls to mind Fordism; Huxley lampooned in Brave New World, and I don’t see any vision more palatable being offered.
            The indigestible jumble of information is of limited use to the treatment of the patient; but of tremendous use to those interested IN the patient.
            EMR’s avoid the Elephant in the Living Room – the actual patient you are treating is right there! The validity of the information from the patient is far more appreciable than for that entered in some distant place and time by somebody.
            Ed, imagine telling your personal information and intimate facts to The Void, that will process them and make them universally retrievable by all authorized dataseekers. The premise is that no illegitimate dataseekers can get your stuff, and that those who do are looking at it for your own best interest. All this emphasis of One Medical Record (to bind them, the phrase follows) is creepy.

  • DeceasedMD1

    Just my 2 cents Jonodoc. Business models do not really translate well into medicine. It’s great for all kinds of HC industries that want to make a ton of money. Lots of fancy testing are toys. Maybe some will be useful. but the robotic surgeries for example have been proven to be a disaster but are continually offered to pts as they generate huge incomes.
    I can see you clearly want to help and have a lot of good in you. But I have to be honest with you. i think to some extent and I mean this earnestly and with respect, you are being brain washed. First of all you are calling patients -consumers. What I think makes teh old profession of medicine special is the doctor pt relationship. Already it is clear you have been taught to call them consumers. Somewhere you have been taught that business model is a good way to solve medical problems. it is actually the cause. SImple corporate greed.(hospitals big pharma, etc.)

    Costs of things have skyrocketed. not from it’s value but from simple greed. Generic meds that are cheap are repatented and now unaffordable. Hospitals charge facility fees (rent) in out pt office visits just to use the doctor’s offices. Plus the fee for the visit.
    In 2009 I believe there were 75% PRIVATE practice and 25% hospital employed MD’s. Now it’s the reverse. Big business and hospitals are not your friend or model.

    • Jonodoc

      Hi @DeceasedMD1:disqus, I used the language of “consumer” and “customer” to draw the very comments that you shared. Walk into any major academic center and you will hear about “customer satisfaction” – it is a part of our medical education. I kid you not – we were instructed using those very same words of “customer” and the like in a 3 hour learning session two months ago.

      In oversimplifying my text above, I am skewing the “empathetic” edge I hope to maintain – that the medical student is the one who spends the most time with their patients, hears their concerns the most, is able to voice those concerns with their health care team, follow-up with their patients, etc. – and these very same medical students could be enabled to make a broader impact on health care innovation given this very intimate patient care process that is akin to Steve Blank’s customer discovery model.

      Business, I am seeing more and more, is one essential part of health care delivery. I wish it weren’t, but it’s not something I’m going to ignore as I move through my training. Business practices need to be humane and keep the patient in mind, but physicians could benefit by learning more about the commercialization of ideas they generate so that broader humanity and patients all over the world can benefit. That learning could and, perhaps, should begin in medical school.

      • DeceasedMD1

        A three hour learning session on customer satisfaction???????!@#$%!! I am just curious. Who taught this class?-meaning some hospital administrator? What were their credentials?

        How did you and your classmates receive it? I know any sort of talk like that sounds boring-but did anyone question what they were “learning”-if you call it that? In your opinion and classmates, is it ethical? Studies show that high customer satisfaction scores are linked with higher morbidity and I believe mortality in pts.

        “Physicians could benefit by learning more about the commercialization of ideas they generate”. You are again talking in a business model here. Not sure who benefits from any ideas but corporate medicine.

        The other thing you face is that the organizations that are suppose to represent us don’t. The AMA makes it’s money on CPT codes. They do not stand up for doctors or pts. The majority of docs don’t belong. Hope you create a better organization to support your ideas.

        • Jonodoc

          Hi @deceasedmd1:disqus, to be fair, it was not a 3-hour session on customer satisfaction but rather a communication training module that often often used the word “customer” in place of patient. Still, my classmates universally felt repulsed by it, as did I. Interesting to hear that there are studies out there that have looked at customer satisfaction and outcomes.

          I hope I am able to work with better organizations to support innovation in health care as my classmates and I head into the future, as well!

          • DeceasedMD1

            So what were the credentials of the “communications” expert telling you guys how to treat the customer? The problem is this problem is every where. Look up press ganey. They are a billion dollar business venture that surveys how happy pts are and many MD’s complain on here that they get flack from admin if they get low scores. The problem is you might be doing your job, by making pts unhappy. such as not giving out narcotics to addicts.

    • Patient Kit

      Hi DeceasedMD1 (Is there a DeceasedMD2?). I totally agree with you that the profit-driven business model is at the heart of what is ailing the American healthcare system and it is alarming to see a new crop of med students being taught to keep consumers happy instead of treating patients.

      That said, my surgery this year was done robotically and, as a patient, I must say that surgery was much easier to bounce back from physically than open surgery that I had in the past. My surgeon does both and we went into the OR knowing that it was possible that he might have to convert to open surgery. I’m very glad he didn’t. I had zero complications, I only had to stay in the hospital overnight one day (surgery at 7am on Tues, home by 5pm on Wed), I could take a shower the next day as long as I didn’t scrub my abdomen, my incisions were dime-sized tiny and I can barely find the scars a year later. The dx of cancer was hard but the surgery itself was “easy”. Of course, the robot is only as good as the surgeon working with it. Maybe I was just lucky but I loved the robot.

      • DeceasedMD1

        LOL. I got trouble logging in as Deceased MD so I just changed it to adding a 1. One day I hope to be just back to Deceased MD! So glad your surgery was so easy and successful. It sounds like you do have a wonderful surgeon with great skill. I am not a surgeon but just from reading and surgeon colleague there have been problems. Don’t pretend to be an expert on it but I think skeptical scalpel wrote about it on here.

        • Patient Kit

          I’m relieved to hear that nobody has stolen your identity and started posting as a second DeceasedMD. I know that there is some controversy about whether robotic surgery is worth the extra cost, but I don’t know whether it’s been accused of a higher complication rate. I just thought I’d share that my particular experience with robotic surgery was very good. I give my surgeon, not the robot, the lion’s share of the credit though. The robot is only a tool; a big expensive tool, but still a tool. And I would never want a tool alone to do any surgery on me.

  • Mike Henderson

    While reading the comments, it is apparent the differences of opinion seem to divided based on the generation of the writer. I can see valid points on both sides. However, I have a basic question for each.

    First question is, do new, innovative ideas really fix the problem with our health care system? I looked up the Eyescribe and think it is a great idea. However, like most older physicians and myself point out, it is the lack of time that is the main problem. Sure, giving Eyescribe the benefit of the doubt that it can work as advertised, the time we have could be more efficiently used with new technological solutions. But why do we have a lack of time today, when 30+ years ago, we didn’t? It is my understanding internists at one point would see up to 15 patients per day, instead of 25+. I don’t see how new technology will get us back to that point. The main value of a well trained internist or family practice doc is that when we have time to gather information, learn the patient and come up with a plan of care that is specific for the patient, quality and satisfaction go up and costs could come down. New technology can not completely make up for a lack of time.

    Second, for the “more experienced” physicians, have we not failed the system? Since physicians as a group have failed to keep the healthcare system true to the mission of caring for patients, why should the new generation of physicians listen to those of us practicing for a few years? When my eyes started opening to how the system really works, I better understood the sayings of “The lights are on, but nobody’s home,” and “A ship without a captain.”

    • Jonodoc

      Hi @disqus_DBGAgOvrN6:disqus , that lack of time is a great question. In my limited understanding, physicians are pressured to see more patients in a given day (thus attending to each patient with less time) mainly because of financial reasons. One example: as we build bigger and fancier hospitals, we need to pay for them – so physicians in hospitals need to bill for more patients to help cover that financial gap.

      It is my intent in this article to empower medical students to consider both the clinical problems and the “system” problems facing the patients they see and the physicians they work with during their general clinical year so that these issues can be identified, defined, and worked on by fresh, open, smart minds.

      And we need to listen those “more experienced” physicians as we seek to innovate so that we do not repeat mistakes or pursue distractions. This should be a profession-wide effort, including old and young (my emphasis being on the young); and the innovation need not be only technology, but could also be operations, training, communication, etc.

      • Mike Henderson

        I basically agree with what you are saying. To stereotype, older physicians may have more experience, but are possibly out of touch or have too long been accustomed to the dysfunction. If they really knew what they were doing, would we be in this mess?

        Younger physicians definitely have a different perspective, but perhaps not enough actual experience in the system. However, if you keep your eyes open, you will soon have the experience. I appreciate what you are trying to get across.

        Finally, you can make choices and make the best of the situation, knowing what you value and how the system works. There are two basic choices: do something or do nothing.

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