Sunday, March 19, 2006

Attention Doctors:"Resistance Is Futile"

"You Will Be Assimilated"

This was the message of the cyborg collective known as The Borg in the television series Startrek: The Next Generation. It got me wondering if this is what the Healthcare System is really trying to say to Physicians? It also got me wondering if this is the message I'm sending in this blog at the expense of a more important message. I was reading one of Steve Beller's recent blogs on the importance of vision and found myself making the following comment:

"No individual, group, industry or nation is willing to undertake a journey if the destination appears no better than the point of origination."

This blog started as an attempt to better understand what is commonly referred to as our Healthcare Crisis. There are times when I appear to be leaving the impression that the future of Physicians is rather bleak. This is not my intention. I've come to realize that I must focus my attention on a vision of the future of healthcare that is not only more promising for our society but also attractive to Physicians.

Back To The Beginning

The position I've taken in this blog is that what we see as a Healthcare Crisis is a paradigm shift that is affecting the way healthcare is delivered. This crisis is best seen as the physical, psychological, social, economic, and cultural manifestations produced as we transition from an older, traditional model for delivering healthcare to an emerging, newer model for delivering healthcare. The platform for delivering healthcare in the traditional model was based primarily on the Patient-Physician relationship. The hypothesis discussed in this blog is that this fundamental relationship is being challenged and will be replaced. The new model will be based the Patient-Information Technology Interface. The Physician's primary role as a gatekeeper to the Healthcare System and its wealth of information and services is at the heart of what is being challenged. Nobody looks forward to losing their job and unfortunately this is a point I have emphasized to the detriment of the vision I see for Physicians in the future of the Healthcare System.

E Pluribus Unum

We tend to see the Healthcare System as a monolithic entity but it is really a complex-adaptive system. It is made up of multiple entities each of which is constantly adapting to the changes produced by their collective interactions. Physicians as a group are one of those entities but can be also by seen as individuals each with their own unique set of skills and talents. They will continue to adapt those skills and talents but will also need to have a vision of what role they will play in the future before they will consider relinquishing their role in the present. The growth of information available in our current Healthcare System has put Physicians at a disadvantage for being the gatekeeper and source of all that information. Having this wealth of information is one of the greatest strengths of our Healthcare System, but due to the volume of it, managing it is an impossible task for any one person. I think Physicians will continue to be a source of information and services but will be one of many sources.

There Has Got To Be A Better Way

As our Healthcare System increases in complexity, patients will depend more and more on Artificial Intelligence and Information Technology to act as both gatekeeper and a primary source of information and services. While this may appear threatening to Physicians I think it will ultimately be liberating. In the early days of medicine Interns were called upon to perform many of the relatively easy and mundane aspects of healthcare services such as drawing blood and transporting patients. This became known as SCUT (a.k.a. Some Clinically Useful Training). What a load of crap. It was cheap labor for the hospitals. As hospitals began to hire phlebotomists and transporters this freed up the Interns and Residents to focus on the more complex and important skills they needed to practice medicine. That is what I think Information Technology will do for future Physicians.

Seeing A Better Future Begins With A Better Vision Now

Too much of a Physicians time is spent doing related but not medically necessary work such as documentation, arguing with third party payers, and filling out an endless stream of various forms for insurance companies. Why we continue to fight to maintain this system is becoming the new eighth wonder of the world. Resistance may be futile but no one is expecting us to become cyborgs. We're not going to stop thinking because we have more Health Information Technology. We're going to become better at taking care of patients. They don't need the least of our skills and talent, they need the best of our skills and talents. The Healthcare System I want to be a part of in the future is one that both utilizes those skills and talents and values them. That is the vision we need to create because without it there will continue to be resistance.

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