Physician Perspectives

  • Ten burdens in the current healthcare system from a physician perspective: (Dr Dan Lynch, Dr. Grady Kaiser, and Dr. Kyrstin Ball)

    1. Unintuitive EMR
    2. Documentation burden (to please lawyers/insurance; click too many boxes for “meaningful use”, spend more time in front of a computer than a patient)
    3. Administrative burden (pressure from administration to see more patients so they can pocket more money while we spend less time with patients)
    4. Prior authorization (insurance companies questioning medical decisions in order to save money which could delay care and end up costing more in long run)
    5. Patient’s with no interest in self-care who want a quick fix ("entitled" patients; though it is not all the system's fault, the current reactive healthcare model does not endorse self-care)
    6. Patients with overwhelming medical conditions due to avoiding healthcare because of high co-pays, lack of coverage, or lack of interest in self care (By the time they see a provider, they take more time and resources to recover)
    7. Fighting insurance companies for appropriate reimbursement
    8. Time constraints (superfluous responsibilities/duties irrelevant from a clinical standpoint... also patient demand outweighs physician supply)
    9. Established reactionary culture within the current system. Not conducive to health/wellness/prevention due to time/administration/insurance burdens
    10. Stress/Burnout/Fatigue/Depression from all of the above

  • @danlynch How can we encourage more patients to take care of themselves? What could incentivize the US population to adopt a healthy lifestyle?

  • "How can we encourage more patients to take care of themselves? What could incentivize the US population to adopt a healthy lifestyle?"

    In short, education. But it is much more complex than that.

    Education has to be accessible, relevant, and motivating.

    Accessibility of self-care education needs to be widespread. It doesn't matter whether the education comes from physicians, nurses, schools, television, magazines, internet, emails, mobile applications, billboards, or any other media outlet, it has to come from somewhere.

    In many cases it doesn't even come from the physician. A physician's title is "Doctor", which comes from the latin root docere, meaning, "to teach". But many physicians, for many reasons, only tell the patients what to do. This is largely due to the nature of the current healthcare system (reactive medicine, time constraints, demand > supply, profit motivated) and not due to the physician's desire, or lack thereof, to teach. Education in a physician's office has become, "what you need to do because of your problem is this". There is hardly time for emphasis on any other aspect of the problem, such as prevention. And I don't mean to say that physicians are the only ones that should be teaching. All healthcare workers are trained to educate patients, but like physicians most lack the time and availability to do so.

    Another problem with the accessibility of self-care education is funding. The person that would gain the most from good self care education is everybody and nobody. Everyone would benefit, but no one would make money. Pharmaceutical and Insurance companies spend large sums of money to educate people on the use of their product... so they can sell their product and make money. Where are the large sums of money to fund self care education? Who is willing to fund such education with the understanding that, from a monetary standpoint, it will be a total loss.

    Self care should also be relevant. The message has to apply to the individual in order to motivate the individual. There is less of problem with relevancy of self care education than with accessibility or motivation. Self care applies to everyone and is mostly universal, but none-the-less, education must be relevant to the learner in order to motivate them.

    Finally, and most important in my opinion, is that self care education must be motivating. Motivation, like emotion, both come from the latin root motere, meaning, "to move." So self care education has to move someone to take care of themselves.

    Psychologist David McClelland was a major theorist in motivation. He described three primary motivators for people:

    1. The need for power in the sense of influencing or impacting other people. McClelland distinguished between two kinds of power. One is selfish, ego-centered power, without caring whether the impact is good or bad—the kind of power displayed by narcissists, for example. The other is a socially beneficial power, where you take pleasure in influencing people for the better or for the common good.

    2. The need to affiliate; taking pleasure in being with people. Those who are high in this affiliation motive, for instance, are motivated by the sheer pleasure of doing things together with people they like. When we're working toward a common goal, people motivated by affiliation find energy in how good we'll all feel when we reach that goal. Great team members may be driven by the affiliative motive.

    3. The need for achievement, reaching toward a meaningful goal. Those high in the need for achievement love to keep score, to get feedback on how they are doing, whether this means just hitting their numbers for a quarterly target or raising millions for a charity. People who are strong in the achievement drive continually strive to improve; they're relentless learners. No matter how good they are today, they're not satisfied with the status quo; they're always trying to do better.

    Using a self care message that services these primary motivators is important in order to MOVE people to focus on THEIR health and wellness.

    One very good strategy would be the power of narrative. Patient accounts of hardship and recovery are good motivators since they do appeal to a person's emotions and are relevant. But they need to be relevant and accessible also.

    Pharmaceutical companies are very good at this, and again, it is one reason they put lots of money into their patient education/advertisements. Their advertisements are usually relevant to their patient's health problem, motivating to the patient by showing a vision of change in a narrative format, and widely accessible due to the funding.

    I hope that in some ways helps to answer the question.

  • Thank you Dan! It seems that Education is key. This is something we are working on at Citizen Health.