When we forget what we are here for
People are usually drawn to healthcare because of a certain calling. A strong desire to be of service to others. To innovate. To make a difference. It's particularly true for doctors and nurses who are on the forefront of medicine.
I spend a lot of time in the company of doctors, administrators, technologists and other healthcare professionals. In various stages of their careers.
What I find is an industry that has gotten so complex that it makes people forget the original reason that got them started.
It doesn't help that there are many things that come in the way.
Regulation gets in the way
Regulations that are supposed to protect the system, often come in the way of care. Consider MACRA (a new law that in the US) that's 2,398 pages long. Do regulators expect doctors to read and interpret this long rule? Who pays for the costs associated with such increased regulation?
ICD-10 (the new disease classification codes) have bizarre codes to wade through. For example, Z63.1 is a code for "problems in relationship with in-laws" (ahem).
Even better, V97.33 a code for "sucked into jet engine". It has three sub-codes: initial encounter, subsequent encounter, sequela. The rule-makers seem to suspect you could get sucked into a jet engine - not only once but also subsequently!
Welcome to the world of hundreds of thousands of little rules that govern healthcare! Imagine how creative the job must be for someone assigned the task of coming up with these codes.
Healthcare regulations have complicated life for many a doctor. Putting a wedge (and a tedium) between them and their calling. It gets in the way of doing the right thing.
Technology gets in the way
As of May 2016, the U.S. doled out $34.6 billion in meaningful use incentives. To encourage healthcare providers to digitize their medical records.
Digitization of medical records was supposed to improve access to information. But old technology, competitive dynamics, and arcane rules make it challenging to share medical records even between two hospitals on the same street. Most doctors dislike their EHRs and view technology as a needless cost and administrative burden.
EHR implementations have run into hundreds of millions of dollars. Sometimes have led to executive teams getting fired.
There are a few problems here.
One, technology cannot improve broken processes. In fact, as Bill Gates observed,technology magnifies inefficiencies of broken operations.
Second, when we spend a lot of money on something, we hunt for ways to monetize it. This often comes at the detrimental cost of selling more to patients.
Broken technology applied to broken processes has made the practice of medicine into drudgery without offering much meaning. Adding layer upon layer of complexity to the more direct, perhaps simpler, act of healing a human being.
Patients and their families get in the way
We've begun to treat patients as buyers of care. Earlier, doctors might have been patronizing but were more open to guiding patients make wise medical choices.
Now the industry fears upsetting their customers who feel increasingly entitled - not thankful - to the care they receive. If you don't cover all bases, your customer or her family may even return to sue you.
Therefore, patients are made to go through several types of tests, provided lots of information, and encouraged to make their own decisions.
A patient confused with a traumatic condition only gets more confused when the doctor says, "Here's what the evidence says. Now make your decision."
What should she exactly do?
Money gets in the way
Financial incentives in medicine are skewed. The fee-for-service insurance model encourages more procedures and prescriptions. Well, we get what we pay for. A lot more medicine than is necessary.
A 2001 study reviewed 4,000+ Medicare patients from 173 hospitals in five states. Using established rules, the researchers asked a group of outside cardiologists to review the care given. 75% of bypass surgeries were considered appropriate but only 30% of angioplasties were required. Surgery was unnecessary for about 168,000 people who underwent angioplasty and 40,000 who underwent bypass surgery. (Reference: Chapter Broken Hearts in Overtreated by Shannon Brownlee).
Not just the $100+ billion heart surgery industry but also other areas of healthcare reveal a pervasive use of medicine without clear or better outcomes. Even when it comes to terminal illnesses.
Atul Gawande writes in Being Mortal: If terminal patients - rather than insurance companies or the government - had to pay the added costs for the treatments they chose instead of hospice, they would take the trade-offs into account more. Terminal cancer patients wouldn't pay $80,000 for drugs, and end-stage heart failure patients wouldn't pay $50,000 dollars for defibrillators offering at best a few added months.
The more medicine tunes itself to ill-suited financial gain, the farther we move away from our internal core. Higher calling takes a backseat.
When we forget what we are here for...
When these and many other diversions come in the way, we forget what we are here for.
Devoid of all its layers, healthcare is a simple act of one human being caring for another. Providing care and comfort. In moments of pain and often confusion.
When we forget what we are here for, we get swayed by the very distractions that initially frustrated us. We become those distractions. We desensitize our inner being and tell ourselves to be more practical. To learn the ways of the world.
Then one day we wonder why our careers have become banal. Meaningless. But life gets in the way of making drastic changes.
We silently accept our situation and spin wheels until the years roll by. And wait for our time to be over.
Unless, of course, we wake up midway. And ask ourselves just one question.
What are we really here for?