Return the clinician to the center of the health care experience

I recently spent time at the New York eHealth Collaborative’s Digital Health conference.

The meeting was full of interesting seminars, informational sessions, presentations on innovative technology looming on the horizon, and talk about the future digital face of health care.

The hallways outside the conference rooms were full of administrators, legislators, consultants, and representatives of companies building and designing new resources to help transform the health care system as they see it.

Over and over again, we were told about the sorry state of the U.S. health care system, how we are first in cost and last in quality, and there’s something inherently wrong with the way “we” take care of people in this country.

No one can deny this, that there is incredible waste, that we do things without great evidence (or often ignore evidence altogether), that our systems are tremendously inefficient.

But it’s not clear that simply redesigning the system from a nonclinical perspective is the answer.

Many of the health care thought-leaders at the conference talked about what they see as the problem with the system, why we needed massive amounts of data to be collected and controlled by the state, why we were not using our data correctly, and why it is clear that we have been doing things wrong all along.

Are we allowing the health care system to be transformed by people who should not be transforming health care? Is it really the best thing for our patients, for the health of our nation, for the financial integrity of this country, to have the people who seem to be taking control of this being the ones in charge?

Now, believe me, there is no way that I am suggesting that we should put a bunch of doctors in charge of this process. We may be really good at clinical care, but I suspect we would be lousy at designing a system of data storage, information exchanges, even simple stuff like measuring quality and outcomes.

That is what consultants are for, and other specialists trained to think about these things.

We need them. But they need us.

Much of the conversation seemed to be about building all of these data collection systems and care coordination packages at the expense of the role of the providers of care; at times it felt like they were wishing we were not even involved at all.

Over and over again, no matter where these presentations were headed, we heard that up to 80 percent of total health care spending is accounted for by the sickest of the sick and for the care of chronic medical conditions.

Do they really think that they’re going to be able to do that without doctors and other providers in the trenches managing those patients?

It’s clear that we need help, that we are not getting our diabetics under control, that patients are not compliant with their medications, that patients are slipping through the cracks, or getting readmitted in less than 30 days.

But in the short amount of time we are given to see our patients we are unable to fully get a handle on all of the subtleties needed to help our patients get to their healthy goals, to overcome all these barriers and shortcomings.

We must decompress the load of doctors so they can better attend to the actual provision of medical care. It must be about getting them the resources and other assets they need to continue care beyond the walls of the office, because that is where most of a patient’s health happens.

Care coordination without care will not cut it.

An expert in electronic health records (EHRs) I spoke with at the conference told me that EHRs are designed to make programmers’ lives easier — not the lives of the clinicians who use them.

We need to turn this around, to turn it upside down, to return the clinician to the center of the health care experience — standing beside the patient with all of their data, their apps, their metrics, and helping guide them towards health.

Interacting with all of the rest of the system, be it a health care information exchange, a patient portal, a care coordinator, a wearable device, or a community resource, will prove to be an incredibly important asset to the health care system and an integral part of patient health as we move forward in the 21st century.

But it cannot be enough. The relationship between the patient and their primary caregiver is crucial and should not be ignored any longer in the discussions of transforming our health care system.

As I’ve written about for over a year, our system is broken, and providers are burned out, fed up and frustrated, and looking for help.

When hospital administrators and thought leaders and legislators design systems to transform health care, we are concerned that they are not going to help us be there for patients in the way that we trained, the way we expect to be there, the way we demand to be there for our patients.

When I returned to work on Wednesday morning, I was met with an avalanche of messages, results, cc’ed charts. One of the first ones I noticed was an urgent high-priority message from a nurse in the neurology clinic, who had sent a message to our practice asking the patient’s primary care provider to generate a referral for the patient to be seen by the patient’s primary care provider.

My poor intern, not knowing what to do about this, filled out a referral from herself to herself and sent this to our administrative task list for processing. Much to my surprise, they processed it and mailed it to the neurology clinic for them to allow the patient to schedule an appointment to see us.

This makes no sense, but it is par for the course. Not only does this waste everyone’s time, but it is an insult to our professional integrity that we’ve let the system come to this.

The time has come for a little rabble rousing, a little revolution, a little noise.

Every time someone decides that the health care system needs to be transformed, they think that no one’s ever thought of changing things before, and they forget that the last time everyone met in large conference rooms and presented PowerPoint slides that show the latest and greatest in current thinking, they were also very sure that this was going to make all the difference, that this was going to solve everything.

We, the health care system in this country, are not good at learning from our mistakes, and we recreate the wheel with abandon.

Ask for our help, and we will gladly give it.

If you don’t ask, we’re planning on giving it anyway.

Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home

View 12 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories