Don’t Squeeze, Tie, Slap or Bite the Hand that Feeds You

Dear Health Care Business Leader,

I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage “on the side” while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the science and “guidelines” of medicine to individual patients with multiple interwoven problems with disease presentations that seldom match their textbook descriptions.

We need each other, at least under the current “system”. So I ask you to view us as allies, because we actually do the work that ultimately pays your wage or your profit, and is the basis for your own performance metrics. We are in this together, like it or not, so let me ask that you don’t do some of the things that several of your colleagues are doing:

Don’t squeeze us too hard.

When you do, the quality of our work, the health of those we serve, is in jeopardy. Instead of just imposing productivity targets, quality thresholds or pay-for performance schemes, listen to what we need in order to keep our patients healthy. Invite us to the table; we actually know a lot about how to work smarter, faster and better, so don’t be afraid of our participation. If we feel squeezed and abused, you will get perfunctory performance, but if you partner with us, we can, together, make patient care much better.

Don’t tie our hands.

I know you mean well, but when you pick or design tools and workflows for us to use, you often make it harder for us to do the work that patients need us to do well.

Don’t give us EMRs that cut our productivity in half, when computers have streamlined work in other sectors; don’t make assumptions about how doctors think and how we process information. For example, let me read CT scan reports and other test results, without scrolling, right when I see my patient in follow-up, import them into today’s office note, and “sign off” on them right then and there, not after my office hours when I should be spending time with my family. And, also, when I am in today’s patient note, let me see all recent results, consultations, calls and refills WITHOUT clicking on several “tabs” that may not have any results under them. Data is meaningless without context, and a good computer system should enhance the context behind the data.

Don’t slap our hands.

Doctors are highly motivated individuals, who generally work harder than anyone asks them to. If we don’t seem to do what you want us to do, it is either because we think you are asking us to do the wrong thing or because you haven’t given us the tools to do the right thing. We don’t need to be prodded along like cattle, and we don’t respond to being slapped.

Don’t bite.

Don’t inflict pain and don’t threaten us with it. Our first inclination will likely be to take care of our patients and ignore you, but we will ultimately respond if threatened or attacked enough. You may think of health care entrepreneurs from the business community as introducers of disruptive change, but consider the possibility that physicians, if pushed too far, could be the ultimate disruptive force in health care.

3 Responses to “Don’t Squeeze, Tie, Slap or Bite the Hand that Feeds You”

  1. 1 Barbara March 25, 2016 at 3:12 am

    Well said!! Now if only they will listen and actually care…

  2. 2 meyati March 25, 2016 at 6:28 am

    Well said. Personally I don’t think that these business leaders will listen, as they are too invested in #1 money$$$. #2 power, #3 wanting a resume-FAME, #4 wanting to claim intellectual superiority over doctors and patients.

    I think American medicine went down hill when it began the “WAR ON—-“. Somehow the physicians through the 1940s -1960s knew that patients presented with diabetes, cancer, heart conditions, constipation, high blood pressure, problem pregnancies, and obesity. They knew that they had to educate patients and treat them the best they could. Sure, they didn’t have today’s data and science created by Dr. Bruce Porche as presented in Porche Index Cognitive Assesment, but physicians had more freedom to treat patients individually for what they really had.

    When I got on medicare, I had to join an Advantage Plan that is tightly run. It was a financial neccesity in a state with a doctor shortage. I was handed a personal history sheet. It did not have any questions about cancer, but it did have questions about cholesterol, lipds, BP, CVAs-coronary and cerebral, hearts, diabetes. I marked, No, no, no, no, no, no, no, and no.

    I was told that I was a liar. I told them that I wasn’t lying, and why didn’t this ask about cancer and thyroid. I was told that this state has a focus on the real health problems in the state-diabetes and problems caused by cholesterol. Cancer wasn’t a prolem in this state according to Medicare and the NIH.. Really? I still don’t have high cholesterol or diabetes. I now see oncologists 2X a year for guess what— The shame is that my cancer could have been nipped in the bud, if anybody listened to my complaints and family history–too bad for me that this state was only at war with diabetes and cholesterol, now we can add the war on prescription opioid abuse. In this state-well you know what I’m going to say—–

    I feel that one of the reasons there are wars against—-is to tightly control physicias and medical care. People talk about all of the check boxes on the EHRs. Let’s admit it it- the check boxes are about fighting these wars. I’m not privy to seeing my chart now, and what the doctor really says, but they spend all of their time checking boxes that they went over glucose, because I am in my 70s, they have to advise me about life style to fight diabetes, etc. Wasted Time for me. Nurses don’t know what to do, because I take 4 meds- Flonase and an antihistimine, because the cancer surgery messed up my nose, ears, and sinuses; thyroid hormone replacement suppliment, and number 4 is Zantac, because modern medicine upsets my stomach.

    I am so tired of spending half of my 15 minutes telling them that I don’t fall, I am safe, No I don’t want to change my diet, No, I don’t lie!! No I don’t want a statin-I hate the NIH-I hate medical wars on whatever-so can we talk about my medical problem and symptoms—- Any more, I interrupt, and say– I’m sorry that the FDA, Medicare, and the NIH isn’t allowing you to be a physician and take care of me.

    lets quit complaining about the EHR boxes and discuss what info goes into the boxes.

  3. 3 R Watkins March 28, 2016 at 9:42 pm

    “I know you mean well”

    No. They don’t. They’re about money – doing good is completely irrelevant.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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