Doctors Need to See the Forest, Not Just the Trees Save

Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from healthcare to the healthcare system, they falter. Stuck in silos, they fail to adjust their focus. They resist systemic innovation. Because they cannot flip, they flop.

This habit -- resisting change, staying focused on the trees instead of the forest -- means that significant system evolution often occurs without physician voices, simply because doctors refuse to be involved. This results in error, inefficiency, and lost opportunity. Paradoxically, when flawed change is forced on the medical system, it burns out doctors. Thus, instead of working as a team, involving themselves from the start in building and growing, physicians become victims of change, reduced to painful irrelevance. Therefore, the failure to build functional healthcare and the miserable state of many health systems is, to great extent, because of the self-imposed isolation of physicians.

A couple of common examples will suffice. Doctors have fought tooth and nail against the precertification process of health insurers. They battle against the payers with the indignant anger of neglected children. However, insurers have been forced into an intrusive system of obstructive payment because doctors refuse to mind their own shop. Physicians insist on ordering what they want, regardless of cost or net patient benefit. Doctors do not watch the henhouse, so someone else has to. It would have been a very different world if, from the start, the medical profession had accepted financial stewardship as part of their mission.

Look at information technology (IT). Healthcare is the last major industry to transition to a silicon base for decisions and communication. Because doctors have blocked IT every step of the way, nonmedical personnel, who often fail to appreciate the needs of doctor and patient, have written electronic medical record (EMR) software. And, because doctors have not seized on the power of the EMR as a patient care tool, the billers and insurers took control, so that the average EMR is not only clinically inadequate, it is focused on coding, posting, and accounts receivable.

If healthcare is to produce the best quality and personal result for every patient, doctors must leave their self-imposed isolation. They must make what can be a very difficult transition -- that of changing of thought from the bedside to the boardroom and then back again, often in the same day.

This requires a different kind of focus. One moment a doctor is teacher. The next, a marketer. The next, a scientist. The next, an isolated responsible decision-maker. The next, a collaborative team player. The next, an emotional supporter. The next, a metric-driven organizer. One moment it's just you and the patient, and the next a roundtable of analysts, administrators, lawyers, financiers, community leaders, and accountants.

Doctors fail to lead in health because they have not become comfortable in each of these roles, and particularly have not learned how to change from one to another, in a moment or an afternoon. Added to this is the emotional drain of being a physician. It is remarkably hard to sit at a bedside with a dying patient and family, watch the monitor go flat, hold a wife in tears and then walk down the hall, around the corner, and sit down at a meeting to discuss ordering supplies, retooling an information system, or hiring a new director. It yanks the mind and soul. It requires patience, experience, and skill.

Nonetheless, this is exactly what medical schools must teach, and doctors should strive to develop. The physician who can bring, in real time, the experience of the patient to the leadership process, tempered with an understanding of how complex biology and business systems interact, adds an incredible amount of value to healthcare. This is critical to the development of medical systems that actually work to the maximal betterment of every patient. Such leaders will be invaluable to the future of healthcare. 

This is more difficult than common multitasking, carrying out two or more similar tasks, simultaneously. For most physicians this is routine. This is the harder skill of changing one's acute focus between entirely different cultural and intellectual functions. However, this is a vital skill for doctors to obtain, because no matter what a physician does, in the operating room or auditorium, in the exam room or corporate office, with a nurse or chief financial officer, she always carries the love and understanding of the patient.

--James C. Salwitz is an oncologist who blogs at Sunrise Rounds. This post appeared on KevinMD.com.

This article is brought to RheumNow by our friends at MedPage Today, where it was published on April 19, 2016.