Incentive or Purpose: Which is it, Doctor?

I have been meaning to share a few thoughts with the community here for the past few weeks about a recent health-care related experience my family and I had. At the start of this new week, a post by Yubin Park (I am a big fan of Yubin's content, and thinking. The link to the referenced post is at the end of this article) really resonated and pushed me to get these thoughts on paper, and hopefully, start a meaningful conversation.

Healthcare has been my focus for most of my professional life. One thing that continues to stand out among the so many talented, incredible, dedicated people I have worked with in this industry, is the overwhelming thread of passion and purpose for the work. Furthermore, almost in every case, this sense of purpose is rooted in a personal experience.

Very recently, my family had an interaction with the US healthcare that reinforced the "why" we do what we do in healthcare. We were faced with a very urgent need to address mental well-being of a loved one. We figured the best place to begin was to engage our primary care physician (PCP) - a member of a long-tenured physician practice, now owned by a very reputable health system in North Texas. We thought, and hoped, that as the quarterback of our family's healthcare, our primary care doctor would put us on the right path and walk it with us. We had consulted with friends and family, who are physicians, who also indicated to follow this course of action.

We took our loved one to our PCP as part of a regular annual wellness visit, the timing of which simply coincided with the urgent need to address their mental well-being. As soon as the PCP heard about the mental health need, they made the following recommendation: "Oh sorry, I can't help you here. So, go ahead and just take your [loved one] to the Emergency Department over at [their health system]. They will take it from there. Now, is there anything else I can do for you?"

I am not a clinician, however, this seemed very wrong to us. This seemed very wrong to my friends who are clinicians. This seemed very wrong relative to the purpose of the job of a PCP. And this seemed very wrong relative the purpose that my colleagues and I at Canton & Company are pursuing. My family and I did not follow this instruction. We took a different path that involved non-pharmaceutical, alternative medicine approaches and some good old fashion care, attention and love. Our loved one is doing much better. So, now onto my point and Yubin's post I referenced at the onset of this article: Purpose

Purpose. The "why" we are doing something. The popular discourse in healthcare is that the way to fix the healthcare system, is to align incentives with the desired outcomes. Makes sense. But, I continue to struggle with the notion of the "business of healthcare" with the the "practice of healthcare". What is the purpose of being a doctor? What is a doctor's purpose? Is it to sustain a (typically small) business? Is the purpose to be healer? The answer is in between, right? No margin, no mission and all that... I think the doctors need to help us solve this. Just like the patients are expected to get engaged in their care to get to the desired outcomes, the physicians need to get engaged in the way they provide care, to get to the desired outcomes (irrespective of payment model). There has been so much focus, effort and attention given to finding ways to incent the doctors to do the right thing... Are you kidding me? We have to "incent" physicians to do the right thing? If a physician needs to be incentivized to cure their patients, they should find a different occupation.

There are so many caring providers. Those that would practice medicine irrespective of their financial conditions. Those that always put their patients first - they are healthcare. They are healers. They are the ones who get the rest of us through. They are the community health centers and the Federally Qualified Health Centers, they are the independent doctors/practices who not only know the definition of Socially Determinants of Health, but take the extra step to do something about it. They are the ones who follow and live their purpose. We as patients can help them serve their purpose. We as patients can seek care from them, help support them, and in return get the consumer-centric experience we seek. They exist, and we have the tools to find them and partner with them. The age of consumerism in healthcare is here - if we as consumers do not do our part and nurture it, then it will only remain a topic of conversation.