September 05, 2014|Categories:
God bless Dr. Sandeep Jauhar for speaking up. His essay and interview in last weekend’s The Wall Street Journal cut deep to the heart of the malaise affecting so many physicians. Dr. Jauhar, director of the Heart Failure Program at the Long Island Jewish Medical Center, and author of the new book “Doctored: The Disillusionment of an American Physician" nailed it all to the mast with such beautiful and gut-wrenching honesty: the long hours with increasingly diminished return, the Greek chorus of payers and regulatory agencies invading the sacred moment of care, the all-too-common struggle to choose between hospital employment and independence (i.e., known devil vs. not-known devil), the creeping feeling of having been turned overnight into an overeducated transcriptionist. And on and on…
Naturally, as I read of the “labyrinthine payer bureaucracy” or the difficulties of coordinating care or the absurd telephone tag of getting pre-authorization for a procedure, I wanted to cry out, “athenahealth can help with that!” But the point, which he captured so viscerally and artfully, is that it can all be so hard for physicians who entered medicine with a passion to heal and now find themselves beaten down and disillusioned.
But then he said something that didn’t sit quite so well. Most doctors, he lamented, go to medical school to help people, not to become involved in the business of medicine. There is, he decried, a “commercial consciousness that’s been pervading the profession” that is to blame for much of what is wrong about medicine today. Dr. Jauhar and I part ways there. That ideal of med school sounds great in principle but is deeply problematic. With as much as one-quarter of the average American’s life income going to health care, a fundamental part of a doctor helping people is being commercially conscious — or, what I prefer to think of as consciously commercial.
It’s precisely by turning our noses up at financial consciousness that we’ve arrived at a place where a third to a half of the care people are getting isn’t helping them and where as much as 30% of health care spending is lost to waste. If you want to help people you must get them healthy at half the cost of what people spend today. Sure, there are the occasional “money is no object” moments of care — and thank God we can rally to meet them. Close to home, I think of the Boston Marathon bombing when we overran that medical crisis with blinding force. But the rest of the year we occupy a reality where five emergency rooms can somehow exist without impunity in a five-mile radius. Where a patient who needs arthroscopic surgery in Madison, Wisconsin can save as much as $8,000 by driving 39 miles south for 49 minutes in traffic to Janesville. I know from some of my own clients that even when they can profit by sending patients to a cheaper place, they say they didn’t know there was a difference in price. Or they didn’t think it was their role to ‘shop’ for their patients.
It’s exciting and noble to be interested in human physiology but if you don’t marry it with knowledge of the cost of care, then you can’t serve the full interest of the patient. John Mackey, CEO of Whole Foods and a disruptor in another entrenched and dysfunctional space, has called for a conscious capitalism that “will show that businesses are the true value creators that can push all of humanity upward for continuous improvement.” Physicians, as the value creators in health care, can do the same if they embrace rather than reject conscious commercialism in service of their mission.
The good news is not every single doctor has to read this and believe it. It can begin with a few crazy ones who will steal market share and have people flock to them and show what’s possible.
So, I say to Dr. Jauhar and to others who share his sentiments: Don’t abide. But go in twice as hard with the morality and the passion that fuels you and smoke the dark side of the overpriced medical centers that continue to operate in a half-conscious commercial way. Yes, it’s unfortunately all too possible in medicine today to do well while doing bad — and just as easy to find yourself doing poorly despite doing good. The hardest thing is to do well by doing good. But that is what will turn disillusionment into hope.