The demise of Independent physician practice: Technology, Policy or Tunnel vision?

Physicians are a peculiar breed of professionals. They usually take pride at what they do and are always willing to take that extra step when necessary. They generally put their patients before their personal interest. For that reason, it takes overwhelming dedication, diligence, discipline, and hard work to earn the title of “M.D.". An expression, the medical profession is a lifestyle of discipline second to the military is commonly prevalent among physicians or at least the ones I can relate. It requires vigilance, organization and being ready whenever needed. Failure to adapt is considered shameful thus giving up is a taboo. Despite all said, unfortunately, there is always room for exceptions to that rule. Some burnout, a few make mistakes or even become negligent. But bitterly majority of the later probably points to how one can deal with the strenuous nature of the doctor’s lifestyle.

Tradition, discipline, and mastery of medicine and doom of the Tunnel vision

As a junior intern after 36-hour tenacious sleepless call taking care of my patients, I recall rushing to the morning report. It was my turn that morning to present one of my interesting cases from the night before to the audience of one hundred physicians. As confident as I was about my diagnostic workup, cruising confidently down the list of my differential diagnosis, that was it! There was one that I miserably missed! That was the first and the last time I was drilled to the hot seat. No doubt, it was one of my worst professional experiences ever. Yes, “tunnel vision”.

Of course, even though missing that one differential did not affect my concluding diagnosis, nonetheless I could literally read from his expression that the attending physician was not exhilarated. Being at the spotlight, by all means, is probably one of the vilest if not the most demeaning experience for a typical medical doctor, more so if in front of a large audience. Due to the traditionalist attitude, physicians inherently are bound to certain platitudes dictated by virtuous standards. Hence, they will stride to avoid negative feedbacks at all cost whenever possible. A stance even though sound intended but conveys a significant burden on physicians' personal life, often causing fatigue, anguish, and burnout.

Clash of culture, norms and ethical obligations surrounding the medical profession

The culture and norms around the tunnel vision by no means is exclusive to diagnostics as it often swirls repeatedly around the healthcare. The rhetoric’s like: One should define and apart between business and the practice of medicine; I only want to practice medicine; health insurance is the healthcare; healthcare is a right; we need to demand politicians for better healthcare and so on have spitefully evolved within the sociopolitical darkness of physician life. As medical professionals, it seems like we have found ourselves at the center of this sprawling woods where all we appreciate are pieces of the landscape around us.

Medical Doctor, Job or lifestyle that is the question!

Medical practice is and will always be a lifestyle not necessarily due to the retentive sleepless hours or commitment to the patients. Thus far, merely because medical practice entails a multitude of social, ethical, personal, political and economic influencers that every physician must ruminate when trying to perform at the top of their professional expertise. And for that, they need to narrow down their blind spot by stepping out of that forest. This too invariably applies to contributors to healthcare administration.

As the norms, ethics’ and culture around the practice of medicine has been turned into an elephant in a dark room by misconstrued driving factors, consequently, the letdown of independent medical practices will be rendered unsustainable.

Similarly, over time the ethical standards of medical business have also been object of adverse attempts, expectedly to the malignant corporate takeover of the healthcare largely by the Healthcare Management Organizations and recent Hi-tech industry. The narrative of “technocracy” is on the brink of explosion. Outcome! start of a sweeping and unethical non-medical industry expansion within patient care, shrewdly, the main strategy and mission of every corporation are prioritizing its fiscal advantage. The foundation of which is the blinded denominator in the healthcare equation, the so-called “Independent physician practice”.

The controversy behind the Practice of medicine and Business of healthcare

It is not only deceitful but is also inattentive to assume for even one minute that a “good physician” should never be rewarded or compensated (either directly or indirectly) for healing a patient, be it through a value-based model, pay for service or any business deal. If we are intending to take medicine out of the dehumanized trap of corporate culture and aiming to place it where it belongs, i.e. “Physicians practice” then norms, values, and morals around the business of medicine must change.

From the advent of the software technology revolution, harnessing the technological potential to address the unending healthcare challenges has been the sole point of focus of current resolutions. Electronic health records (EHR) were developed to help streamline the health information creation, storage, management and sharing among physicians and providers through advances that have repeatedly stumble into a certain set of tunnel visions. Hence, by enhancing billing and scheduling features insurance industry protocols, and overlooking the physician use-case requirements. The eccentricity that lean business practice and efficient billing is the solution to physician burden and burnout has been proven again and again to be counterproductive and has turned out to be the source for dissatisfaction in the medical community.

Similarly, Constant political Partisan approach to healthcare issues has taken the practice of medicine out of its context. Healthcare should neither be an object of the national dispute nor something that needs to be reformed by the hands of politicians. Observing Healthcare with the political telescope has magnified the already presented visions of industries' already misguided solutions. Norm's, ethics about politics necessitate the type of solutions that will not only evade obstructing the practices of medicine but only center on legislation that ensure quality care avoid conflicting with the clinical judgment.

Credibility issues, biased thoroughness and resistance around change and tunnel vision are the limiting elements for any advancement and productive delegation. It takes constant self-awareness, proactive engagement and accepting that there is always more than one side to every problem and variety to the school of thoughts. That the theory of the tunnel vision is more about focusing on intended perception vs objective presentation.

As the fundamental necessity for stepping out of the woods, we need to look at the big picture, make use of different glasses and seek an appraisal from a variety of viewpoints. Consequences of the tunnel vision are disappointment hence the demise of independent physician practice.

Policies synchronized with medical practices vs businesses and technologies are fundamental to quality healthcare

The disproportionate bylaw does not equal to superior healthcare, nor does it help the development of best of the best. The government must look at healthcare through the physician’s lens as an alternative of observing through the telescope of insurance carriers. The tunnel vision created by corporate industries through which administrations look through is the slenderest when focused on physicians and the patients. Current policies are primarily built around information security, interoperability, centralization of data and meaningful use. Why? Commodious to fall back on the policies that are designed to cause physician detachment. The culture of taboo in healthcare and medical practice has not only compromised objectiveness but also narrowed down the field of vision, comprising physician’s ownership of hospital stocks, clichés forcing physicians to shy away from making profits. These types of trends have led to an evolution of customs that unrealistically limit further advancement in technology, policy, and delivery of medical service.

Being a physician is a Lifestyle. It comes with everything that relates to the day-to-day life of a person and more including the task of applying skills to solve a problem called “disease.” Life is not about living to make wealth but making money is the prize for the lifestyle dedicated for improvement of other lives. Failure to convey proper care based on later norms due to the blindsides decisions sets the grounds for independent practice struggle to accept forthcoming technologies and policies that shall serve as the catalyst for the vicious circle of poor solutions, resistance, and botched healthcare. That is why physicians need to do their share of transformation by eliminating the term "I just want to practice medicine". Instead, they need to start taking back what belongs to them, the lifestyle of medicine, and ownership of the domain that comprises incorporating policy decisions, technology and business of healthcare. Medical practice is the healthcare and so is business around it. As science and technology advances, so are the latitude of the lifestyle of medicine hence entails widening the scope of the vision. Most industries have achieved this goal and most professions from engineers to entrepreneurs, business people to politicians have adapted to those changes, but with respect to physicians, such revolution has been quite sluggish primarily due to limits created by biased norms, rhetoric’s and platitudes.

We need engineers to build healthcare technology but need physicians to confirm their utility of those innovations. Physicians need policies that are pinpointed on medical culture and not technological principles. With Technology concentrated around physicians' practice and not on financial and billing philosophy. Medical practices need to navigate those principles to accommodate new trends and tools that will help patients by contributing to the best solutions for Independent doctors. Failure to embrace independent practices will suffer. With the ever-changing science and technology, Small medical practices will need to make up and restructuring. Staying current and competitive involves a broad scope of vision, multitasking and broadening the opportunity of medical education and continuing medical education (CME). Independent medical practices must be empowered. Technology can't function without a strategy, hands-on methodology and personalized approach, the fundamental prerequisite for Healthcare without borders.