Part 3: Where patients think we should be pointing fingers...

Week 3 of our 3 part series on the blame game in healthcare. Week one we discussed us physicians enjoying to point fingers at others who we feel are destroying healthcare. Week two we explored the disconnect between those who think they have the "sure fix" for healthcare and those who live on the front lines. In Part 3, I will give you my perspective and opinion on how we can fix healthcare together.

Overall, it's time to follow the science. Let's stop ignoring the tried and true evidence of how to get better care, at lower cost with better outcomes. It's called RELATIONSHIPS. If you don't believe me, than just google relationships and healthcare outcomes... a few examples I have linked below. It's clear, if you want better outcomes it starts and ends with relationships.

But wait, look at the sure fixes to healthcare.. how many were centered around relationships? In week one, how much of the blame was driven between two groups with a close relationship? It seems pretty simple to me, if we want to fix healthcare than we have to shift the focus of our "fixes" back to driving relationships. As retailers, big box stores, pharmacies, hospitals, tech developers and insurers continue to battle over control.. what about the physicians and the patients? If anyone would ask, my bet is that most of us would prefer a better relationship and not an easy button to a random provider who we don't know personally or what training they have or don't.

Relationships are how we get patients the best care. Relationship building requires physicians and healthcare teams have the time and resources to develop and foster the best care through our relationships. Can you imagine if we encouraged continuity of care, met patients needs at their appointments, knew their medical/social and family histories... ?

Long story, short, we have completely lost our way and our focus on what is truly the source of our failures. We all know why we have less engaged patients and burned out physicians. We have just lost sight of the science and fundamentals or caring.

Patients

Sadly, when most “consumers” show up, it’s typically at the fragmented care site with the hope of a quick fix or the ER when it is too late. Why, because primary care can't get them in, is buried in the EHR, doesn't allow walk ins and is focused on blitzing thru as many check boxes as possible. Even a visit doesn't feel like a visit any more. How many docs "know" their patients? How many patients know their physician? All the tech and gadgets in the world won't work if they don't drive relationships. Why do we keep saying yes to things that move us farther from each other?

Physicians

The rewards in medicine are delivered in hugs, high fives, and interventions that are driven by our relationships with our patients and each other. We want to curbside consult our colleagues and to hear how our patients are in the hospital or when referred. I miss the days when we discussed patients and what was best for them from each of our perspectives.

Yet, we don't know our colleagues any more or our patients. It's not Mrs. Jones in room 3 it's our 830 patient. We have to replicate everything every time to not only check boxes but because we don't know our patients nor where they have been or why. Why is our visit only annually? Why do we physicians and patients keep running on the rat wheel when it doesn't foster our relationships?

On every corner, healthcare.

Why wouldn't patients go elsewhere? If they don't feel connected to the practice or the physician its not surprising they go wherever. Physicians and practices complain about their patients going other places, but few have actually tried to access their own practice. I would encourage practices to try calling or putting in a portal message.. how does that go? Fewer and fewer practices create workflows to ensure continuity. The next available adds to us telling our patients that relationships don't matter to us. Coordinating a referral, checking in on a sick or hospitalized patient... anyone do that any longer?

Hospitals

They used to partner with primary care and specialists to ensure referrals and connections were built. Now, more than ever, they seem to be in competition with those of us in the community. Buying practices, offering direct to consumer care and even competing with each other as they consolidate.

Physicians no longer admit patients, round on newborns or even call docs for followup after discharge. Hospitals work to keep patients out of the hospital after discharge not practices. Our handoffs our faxed discharge summaries from the hospital which is about 20 pages of required check boxes and requires a scavenger hunt to find relevant information.

While in the hospital, patients are handed off every 8-12 hours to the next physicians, ER physician or hospitalist. Most patients are lucky to see the same admitting physician twice in a stay. Care plans seem to change with every day and every new physician.

Insurers:

They don't have a relationship with the patient or the physicians any more. Instead they have moved to having their own call lines, hire telemed vendors, bypass primary care or build their own. Barriers to referrals, connection and continuity seem to be growing. Patients again are stuck behind who's in network and when will the pre-auth be approved. How many physicians talk or even try to speak to the medical directors? The insurers have become unreachable unless you like phone trees and interacting with a bot.

Venture Capital and Private Equity

It seems that more physicians mistrust any and all investors. Investors see physicians as poor in business. Physicians see investors solely as the problem. How many physicians have relationships with vendors, investors etc.. How many physicians lean into "developing" the answers to healthcare problems? Physicians have largely become fragmented and difficult to "sell" on innovation or they just don't listen. Investors tend to bypass the physicians just as physician bypass the investors. The siloes lead to most innovation from the same folks, listening to the same ideas and coming up with the same fixes. The fix often helps one are but creates two more problems.

THE SOLUTION

Let's get everyone together, follow the science and recognize that relationships will drive better care and lower cost. Who is in? If you are, then you realize that the FFS system does not believe in any of these ideas nor the idea of relationships. More consolidation, workarounds, fragmented solutions and siloes driven by our focus on more revenue is just not working.

If you want to excel at more fees you offer more services, it is just that simple. You become tied to the "rat wheel." If you are a practice you over book your schedule, order more tests, don't care who you see, handoff patients, refer patients... if you are a patient you go to urgent care, or don't care for yourself because "more" service and not better service is what we have aligned and your insurance will pay for.

I would encourage all of us to look closely at our own part in the game of healthcare. Are you pushing for a relationship with the same physician? Do you like a full office schedule and seeing as many patients as possible? Do you feel good after a visit? Was it valuable for the physician or for the patient? What about your investments, are they leading to better outcomes? Are your ideas and actions strengthening relationships?

By this time, I hope you notice that I have left the government, policy etc.. completely out of this discussion. It would be nice if they helped, but I can no longer hold my breath. Hope is not a strategy that works. In my opinion, everyone involved in healthcare in some way needs to lead the way to better care. Every role I have highlighted over the past few weeks can play an active role without waiting any longer.

Time for a transformation of our mindset to relationships. We need to target how we offer better care with more continuity through trust that actually makes healthcare better. We need to call the question around claims that our "sure fix" is actually creating better outcomes, lowering costs and driving value. Disruption that fragments care, drives more and not better care should not be invested in by consumers, patients, physicians or investors.

The solution is simpler if we all buy in to the evidence. Do you buy in? It's relationships that change behaviors for the better. It's relationships that will solve physician burnout. It's relationships that will better align investments of time and money into better care.

Believe it or not?

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Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree.?I have no intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes.?

https://www.annfammed.org/content/18/5/422

https://scfnuka.com/impact-relationship-based-care/

https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/benefits-support/pcmh-evidence/