Is there a solution to our health care crisis?

Dr Rademaker- 50_pp

Many are quick to criticize our health care system and they would be right but perhaps for the wrong reasons. Ultimately, if one does not get the health outcomes they want or need, this indeed is a failure. The question we must ask – what is the root cause of this! 

Unfortunately, most will have the wrong answer and simply accuse the doctors and big pharma of greed, amongst other reasons.

The truth is – the ultimate responsibility of our health must reside within us – not someone else. This is a fundamental flaw in our thinking when for political reasons, the belief that health care is our right – is misplaced. Of course it is our right but who must be ultimately responsible?

Without getting political on any of this and point the finger at anyone – it is important to understand the emergence of conditions that have brought us here today. The purpose for this is simply to give the reader the opportunity to actually decide for themselves, why it is so important to start taking ownership of their own health rather than making it the fault of someone else.

I believe by sharing the actual facts as they are, based on science or accurate recording, then we will be in a better position to make the right decision rather than obfuscate the truth, be misdirected and think the solution is elsewhere when it still resides within us.

The facts as I have been able to retrieve.

The problem starts in 1889 when the concept or residency was first put forward. The purpose was to institute rigorous training standards and requiring the residents (usually young men) to reside in the hospital. This mentality is still mostly present, albeit less than before. In truth, perhaps not unlike the training of a Navy Seal, doctors must be prepared to withstand many difficult challenges they will face in helping their patients. This has created a culture of perfectionism, denial, competition, criticism amongst others. Part of the reward in the past has been high salaries and reputation, which is clearly absent today. Doctors no longer get the automatic respect they once experienced, and their salaries are often on par with skilled technicians.

So what are the conditions that doctors face today?

Here is the list  

Physicians face daily challenges in providing the best possible care for their patients

Increased stress

Increased workload

Excessive administrative duties without the proper training or support

Constantly shifting EHR technology and programming requiring too much time to update ones skill

Overextended and depleted emotional and physical resources

Feeling drained and used up

Fatigue

Excessive work hours

Frequent call duties

Comprehensive documentation in electronic medical records

Time spent at home on work related issues

Risk of malpractice

Loss of autonomy at work

Decreased control over work environment

inefficient use of time due to administrative duties

Loss of support from colleagues

Every hour spent on a patient requires 1 to 2 hours of administrative requirements to include patient notes, coding, ordering labs, reviewing labs without any compensation

Insufficient rewards

Limited interpersonal collaboration

Limited opportunities for advancement

Limited social support for physicians

Finally with the information age with digital recording and secret monitoring programs evaluating physician performance while ignoring the human element in clinical interactions and delivering (and the fear of) inappropriate negative assessments based on inappropriate standards

 

While this list is not complete, the problems facing doctors can be summarized as follows in 2 ways:

Work, personal and organization

And

Asymmetric rewards, loss of autonomy and cognitive scarcity

The work burden is excessive essentially limiting the physicians ability to properly interact and manage each patient whereby the sense of accomplishment is reduced, loss of the autonomy to choose how best to take care of the patient, inefficiencies and losing out in life outside of work and creating solid interpersonal relationships with their patients.

In the personal, the typical attributes and the culture engendered in medicine includes the following elements:

Self criticism

Unhelpful coping strategies

Sleep deprivation

Over commitment

Perfectionism – they cant make a mistake

Idealism

Work life imbalance

Inadequate personal support

Denial

competition

And an environment that is constantly attacking the doctors choices and

one that does not allow any type vulnerability

 

Organizational

Negative leadership behaviors

Work load expectations

Insufficient rewards

Secretive monitoring systems that are designed to catch a doctor doing something wrong rather than finding ways to support doctors doing their best

The asymmetric rewards refers to the idea that any negative outcome is a doctors fault and people are on the look out for this while there is little praise or acknowledgement for the lives saved. Doctors have the difficult role to make life and death decisions based on insufficient data at the time that later get scrutinized after additional data is acquired and the doctor found to be at fault. Added to that the financial crisis many people find themselves in today and the propensity of malpractice lawyers, it is often an easy win to take someone to court when the claims are indeed false and frivolous. It is this cloud under which doctors must work day in and day out.

Cognitive scarcity refers then to the increase in the difficulty in making any decisions when all the various opportunistic elements come into play. A study in India clearly demonstrated that farmers needing to make a choice with the knowledge of the financial outcome made poorer decisions that those who did not have the knowledge.

These opportunistic elements are a daily issue in particular the fear of making that mistake and getting in trouble either with colleagues, the institution or be sued.

When you add all of this up. It is no wonder that 50% of doctors are suffering from burnout, ptsd, with high levels of depression and a rate of suicide twice as high of the normal population.

Doctors do not have a way out and all of this leads to depersonalization, exhaustion, feelings of low personal accomplishment, increased incidence of executive dysfunction and depression. Doctors are quitting, changing careers or reducing their hours. It is predicted that by 2025 the US will be short of 90,000 doctors. This of course will result in poor patient outcomes because of the lack of doctors. Adding to the fact that when a doctor is suffering from depersonalization, the interaction with the patient is compromised and treated more like a number than a human being. This impersonal experience leads to poorer outcomes and trust in the patient.

There is no way out for the doctors and the institutional approach completely misunderstands the overall situation thinking that providing the doctors with tools for personal improvement will suffice.

The medical environment is hostile especially certain specialties like emergency medicine, family practice, neurology and internal medicine.

Unfortunately the answer can not be found within he institutional realm since its typically the non medical personnel making the decision and who do not understand what it is like to be responsible for the life and death of a patient meanwhile having every part of their work and life be scrutinized under a microscope with the aim to find something wrong and on top that sacrificing much, little to no rewards and not having the personal quality of life experienced by most other and even less qualified people.

Being a doctor is indeed choice and more than a job – it’s a calling! Medicine is rapidly changing with the advent of new specialties like regenerative medicine, biotechnology and the many entrepreneurs bringing new solutions towards health optimization. The culture within which doctors are trained must leave behind the 1889 idea of what it takes to be a doctor, rather give the doctors all the support they need to thrive, make their own decision and incorporate any of the innovations in health and wellness that have been proven to work – rather than depending on institutional think to determine what a doctor can or can not do.

Said differently, drugs and surgery address the symptom of the problem – not the problem itself. The root cause must be determined and any and all appropriate measures taken to reverse the condition in the most natural and personalized manner. Drugs and surgery should only be used as last resort or as a temporizing measure. All physicians can embrace a minimal amount of training to better understand the components contributing to the root cause like poor life style choices and deliver the information and the resources to their clients to change. Additionally, doctors must begin to embrace the concept of running the business of the business rather than being the indentured servant to their own practice or the other forces governing the way they practice.

Business does not have to be hard and offering your clients solutions for a fee for service will help their bottom line. Not only are patients demanding these solutions, but they are also getting them from all the wrong places and too often to their detriment. The doctor can easily assume a central role in the client’s decision making as they explore different non-medical options for their own personal wellness.

Doctors can easily take a stand for themselves and with just a little coaching have a thriving business, the quality of life they always dreamed of and most importantly, healthier patients.


Bart Rademaker MD


If you are a clinician and want to know more how you can discover the type of independence and the ability to thrive in any economy, reach out to me and we will get you started on the Master Class Fuel: Get back in the driver seat of your practice!

  

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