The disruption of continuity

I read and respond to a lot of posts on LinkedIn. Honestly, I am losing faith as I continually read about how we can "fix" healthcare with data, an app, or a new business model. I read about physicians, nurses and patients leaving because the "system" or "others" are destroying their faith in healthcare.

How about all this "hype" on how artificial intelligence will be the next "fix" to our broken healthcare system. My gosh, it can eliminate bias, instruct doctors on how to care better, pass a multiple-choice test, and soon I bet I will read that it may even perform lobotomies on the politicians writing bad policy.

Last week, I wrote about the failure of digital health. It's not failing because it's bad technology, not a great idea, or isn't filled with promise. On the contrary, it's failing because it's being used to disrupt care and relationships and not strengthen them.

My apologies for my rant, but over the course of my career, I have seen higher costs, lesser care, and more frustrated physicians and patients than when I started. Promises of "better" continue to fail. Care is worse, costs are higher, and yet we keep looking for the "Hail Mary" pass that will magically change everything.

If only... we add data, interoperability, artificial intelligence, virtual care, gadgets, robots, etc... or maybe if docs got paid more, worked less, had side gigs... or maybe we need more virtual care, less in-person care, better exchange of health data, fewer phone calls... or maybe we should just be employed by hospitals and bigger health systems... or maybe add more sites of care so that convenience is king...

It's all a big lie. The disruption of healthcare has not led to better anything. The disruption has led to a complex, fragmented, and redundant system of care that now takes so many more physicians, nurses, billers, coders, and so on to care for one patient. These providers are "burning out" performing inane tasks, checking boxes and trying to care for more consumers of healthcare and less patients. It is the definition of insanity.

Just look at the slide and think about how care was in the first half of my career and how it's been disintegrated in the second half of my last 25 years. It's amazing to think that we have let it get this way. I say "we" because I do believe that my fellow physicians and myself are part of the problem. We have leaned into building, creating, training, and handing off care to others with the false hope of being happier, healthier, and wealthier. We have helped propagate the disintegration of care and now spend more time getting MBAs than working on the fundamentals of our care system... Physicians, nurses and care givers largely went into medicine because they want relationships. They truly want to care and see patients get better. We can't do this if we are just part of a random system and spend our time on meaningless work. We need relationships, workflows, follow-up, daily rounds, team based care etc...to fuel us. Instead, we move farther away and are all less happy, less healthy, and not wealthier for our efforts.

The time has come to examine what has happened to the continuum of care. Continuity, or lack thereof, is why we are in this mess. Physicians spending time on finding where patients have been, what medications they are on, and following up on others' care has replaced simply offering the care ourselves. Instead of using technology, intelligence, process, quality improvement to make care better, we instead use it to foster more complexity, handoffs, and silos.

What if we took back the control of the system or control of our own choices? What if we designed our practices around relationships, continuity, and outcomes? What if technology, data science, care coordination, care navigation centered around fostering a continual relationship with trusted providers? I would bet we would design, buy, and implement our care very differently. I would bet that nurses, clinicians, and physicians would be the new designers of healthcare delivery and not the tech companies, administrators, or random offerings.

What do you think? As a patient, physician, father, husband, innovator, entrepreneur and challenger of the status quo.. I wonder why not? Could we make it worse?