Why Isn't "Health" Practiced in Healthcare?

Editor's Note: Last week's post, "How Do We Solve the Schism in Healthcare?" drew a lot of interest both here and on LinkedIn. Great comments, insights and feedback. Let's keep going. Enjoy. As always, you can find all my blog posts from 2013 to the present on my website at http://stevemarshallassociates.com/steves-blog/

Over the past five years, I have observed the decline of joy in the ranks of physicians as they go about their work. That's right; I said, "joy." For example, I worked with a wonderful primary care group last year which defined their overall goal for the next five years to be, "Growth with Joy." When I have shared this goal with other clients, I have heard a range of responses from outright snickers, all the way to admiration. My question to the detractors of this goal is, "Why not joy?" After all, if you are going to spend 50-60 hours a week, 2100 hours annually, nearly 100,000 hours in a 40-year career engaged in your practice, why not enjoy it? Sadly, I don't see many physicians doing that. I think that while there are many answers as to the why of this question, I will focus on just two that I see as the drivers for this dissatisfaction and, "lack of joy."

Answer #1 - Meaning
Every day, we are reminded that the health care system is in crisis. We are going bankrupt. There are too many lawsuits. We practice defensive medicine. We restrict access. But surveys of doctors indicate a problem that penetrates much deeper than this. Today, more than 50 percent of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment. Medicine is facing a crisis, but it’s not just about money; it’s about meaning.

This shouldn't come as a surprise; I am not a physician, but I am very familiar with the curriculum of medical schools, and it has been hard to find any courses, (until recently), that would address this issue of finding meaning in the work of a physician. Medical education has often been characterized as an abusive; sleep deprived, extremely stressful, and a fearful system where students are inculcated with fears of making mistakes and, more importantly, where the message is clear - keep your doubts and fears to yourself. Traditional medical training is founded on the premise that, while you should be empathetic, show compassion, and be altruistic, the underlying message is that you must retain a "professional detachment" in your work to ensure objectivity.

The Perfect Storm
"Healthcarewill change more in the next five years than it has in the last 25 years," I say this almost on a daily basis to physicians who are walking around in shock over the number of changes inherent in the Accountable Care Act and healthcare. This has forced them to work more quickly and take on any more administrative burdens than ever before. What it has really done is take them away from the primary reason they went into health care - taking care of patients. Worse, it has lead to a bumper crop of medical errors, substance abuse, and people either not entering the profession or leaving the profession. All this, in a time, when the demand for physicians will grow sharply - 17% by 2025 - while the supply of physicians will decrease by 90,000. These numbers come from the AAMC (Association of American Medical Colleges), but, since it takes ten years for physician training, the action to correct it needs to happen today.

How Can We Help Medicine Overcome its Own Illness?
That’s a question that has occupied Dr. Rachel Naomi Remen for decades. Remen is a clinical professor of family and community medicine at the U.C.S.F. School of Medicine and the director of the Institute for the Study of Health and Wellness, at Commonweal. Over the past 22 years, she has been advancing a powerfully subversive addition to the medical curriculum, a course called The Healer’s Art.

For the first six years, Remen taught it with ten friends, all community physicians drawn from outside the school. She was half afraid that her dean would discover it and throw her out. But gradually, the course began to spread by word of mouth, to two schools, then four, and then 16, then 25. It is now taught annually at 71 schools in the United States (half of the nation’s medical schools) and schools in seven other countries.

More than 1,600 students take the course each year and about 13,000 have gone through it. And while it is described as a simple elective — a 15-hour course is given in five three-hour sessions — many of the doctors who teach it, and the students who take it, see it as part of a movement. In evaluations, large majorities of students say the course fills a gap in their medical education. It helps them to feel more committed to medicine, more supportive of their classmates, more confident that they can be good doctors, and more clear about what they can personally offer patients. More than 95 percent of them say they will recommend it to other students.

My conclusion - I believe that, with the proper structure and trained staff, that there should be little to no deterrence for physicians to able to find meaning in their work with patients.........as long as they can do that.

Answer #2 - Organizational Health
There are three bad character traits of physicians I have noted over the years that are necessary to correct for the future of "Joy" in healthcare and within the physician ranks:

1. Lack of entrepreneurial spirit;

2. Aversion to conflict; and,

3. Tactical thinking.

A. By a lack of entrepreneurial spirit I mean simply, that, physicians tend to be more expense oriented than income oriented. This trait can lead to myopia and a focus on preserving scarcity rather than creating abundance; something which is much needed in preserving the autonomy of a medical group.

B. By no means is this behavior of aversion to conflict solely limited to physicians, but I will focus on them for this article. A general lack of understanding (and fear) of how to have good conflict and that, really it is the first step in reaching resolution means that most people avoid conflict like the plague. Also, personal conflict and professional conflict are very different; personal conflict is what most people think of when they hear the word conflict - yelling, screaming, insults, and even physical violence - is what often comes to mind. Professional conflict takes place when people can focus on the present:

  • Make "I" statements (vs. "You!");
  • Avoid jumping to conclusions;
  • Avoid thinking in all or nothing terms;
  • Attack the idea and not the person; and,
  • Don't base arguments on emotion.

This, like many skills, takes training and practice.

C. This is one of my favorites; tactical thinking. In a planning session with a physician board, when I was explaining the hierarchy of planning from first the "Why," next to the "What" and then finally the "How," I had a physician blurt out his frustration with this process, "I don't think this way!"  He went on to say that physicians are not trained in this manner, and this was really hard for him. I immediately thanked him for his honesty and used it to springboard into asking others if they felt the same way - they did. Physicians that want to stay independent of employment will need to become more strategic in their thoughts and actions, lest they want to become part of a large healthcare system.

Physicians finding meaning in their work and organizational health encompasses much more than just these three character traits, but it is certainly a good start on creating a "healthy" approach to the healthcare environment.

NEXT WEEK: OK, I Am Convinced; Where Do We Start?