The Long View on Health Care

Quality endures.  Investing the resources necessary to establish a solid foundation always pays off in the end.  Always.  The foundation of health care is the delivery of health care services from a physician to a patient.  Over time layers of excess have been added to the foundation.  The layers did not strengthen the foundation but rather weakened it.  The additional layers not only weakened the foundation of health care, the doctor-patient relationship, but added cost with little in return.  As layers of excess were being added to the foundation the external environment was changing as well.  The system was appropriately deemed no longer financially sustainable and cut backs in funding were implemented.  A disastrous situation.

Enter the corporate model of health care management.  While there are some institutions in the U.S. that are managed by physicians (actually the more successful ones) in most health care systems the top 5 layers of leadership have never practiced medicine because they were trained to be business people.  They don’t know what its like to be face to face with another human being who has just been diagnosed with a terminal illness.  That is not and should never be looked at as 15 minute new patient visit.  They have never experienced the frustration and self-doubt that follows when a physician has apparently done everything right and a patient still has a bad outcome.  They have done nothing to fix the broken foundation of health care because they were never trained to do that and don’t know how.  Rather, the corporate model of health care knows one thing: fix the bottom line.  So for years health care administrators have had a singular focus.  They have spent decades, as the saying goes, putting lipstick and perfume on the pig.  The focus has been on how to make this month’s balance sheet look better than last month’s balance sheet.

Now it would be naive to think that there was no fat to be cut out of the system.  And one can never discount the importance of operational efficiencies.  But for years the crumbling foundation has been ignored, layers of waste have been added to the foundation and the focus had been simply on making the bottom line look better.  No one saw this coming?

Every decision in health care now has to be made with one question in mind:  How is this going to help physicians provide quality health care to their patients?  And the layers of weight on the foundation need to be reassessed.  Is there value there?  Re-establishing the doctor-patient relationship requires re-establishing the culture of health care.  The profession of medicine must be redone.  Physicians should first and foremost realize that they in the business to provide a very important service to society not purely for self enhancement.  Physicians should be encouraged to read, read and read some more rather than work, work and work even harder.  Isn’t that one of the key differentiators between a profession and a trade?  The patients need to become more engaged and set the bar higher for their physicians.  They should expect an encounter with a highly educated professional who does as much listening as they do talking.  The encounter should be educational.  It should be personal.

Health care doesn’t need more myopic fixes on the bottom line.  Someone needs to have a plan with the long view.


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