Author Dr. John Bishop: 5 Things We Must Do To Improve the US Healthcare System

I advised my students over the years that we surgeons are there for the patients, not the other way around. And that if a patient feels like they need to be seen, then bring them in and see them. And that if a patient can’t afford to pay a balance after insurance, then write it off. And that the joy of practicing medicine, and the reward you get from that, is to see a happy and grateful patient. And never forget the words of Tim McGraw’s song, “Always Be Humble And Kind.”

As a part of my interview series with leaders in healthcare, I had the pleasure to interview John Bishop MD.

John Bishop is the author of Act of Murder and Act of Deception. Dr. Bishop has practiced orthopedic surgery in Houston, Texas, for 30 years. His Doc Brady medical thriller series is set in the changing environment of medicine in the 1990s. Drawing on his years of experience as a practicing surgeon, Bishop entertains readers using his unique insights into the medical world with all its challenges, intricacies, and complexities, while at the same time revealing the compassion and dedication of health care professionals.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

I graduated high school in 1965, college in 1969. One of the biggest worries for myself and my fellow students was the draft. Although my father was a career Army officer, he felt it was most important for me to get an education and try to avoid getting drafted. Although my plan was to go to medical school, which had it’s own deferment plan, my father was insistent that I join ROTC in college, to “hedge” my bets I believe were his words. I had a great appreciation for the military, having lived it with my Dad, but I myself was not a particularly good candidate for military life. I played music and had long hair, the trappings of a liberal, anti-war renegade…which was far from the truth…, so ROTC and I didn’t fare well together. As Fate would have it, I had to go for a physical at the beginning of my junior year, the time at when a temporary “commission” was issued for ROTC participants. I had Rheumatic Fever when I was twelve, and although I was fit and free of residual effects from the disease, including the absence of a heart murmur, the doctor told me I was unfit for military service, and dismissed from the ROTC program. I remember all those days and nights of worrying and planning to continue my education, and to either avoid or delay military service, and it turned out that I was 4-F all along. I learned from that incident that Wasted Worries are just that and avoid them when possible.

Can you share the most interesting story that happened to you since you began leading your company?

I spent the first half of my Orthopedic Surgery career in an academic position, and had a full schedule taking care of seeing patients and performing surgery. In addition, I taught medical students, residents, and fellows. I was expected to present papers at national meetings and write articles about innovative techniques in my field of expertise, the so-called “publish or perish” mantra in the academic world. After twelve or thirteen years of that routine, I burned out. I wanted to continue taking care of patients, which is why I chose that field to begin with, but I had enough of the academic side of things and wanted out. The Department Chair saw things differently. If I was to keep my position, I would continue to present papers and publish, as I was one of his more prolific producers in that arena. Otherwise, I would be invited to leave, and join another group as I saw fit. I would be stripped of my academic titles, and of course he felt I wouldn’t want that, and he felt comfortable I would remain under his thumb. I resigned the next day, moved out of academic space, and joined another group less than a mile down the street, and continued my busy practice without a glitch. That was the best career decision I ever made. Point is, one can spend a great deal of time pursuing a path, and maintaining that path, but at somewhere in time, you may not be happy and need to change direction. Don’t be afraid.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

Back in Medical School, the first two years were mostly classroom activity. The third and fourth years were the clinical years. I had rotated through all of the medical services, Cardiology, Endocrinology, Gastroenterology, Pulmonology, etc., and nothing struck me as something I wanted to do the rest of my life. I had also rotated through family practice, OB-GYN, general surgery, cardiac surgery, even the specialty services, like Ophthalmology and ENT, and by my senior year, I was panicked that I couldn’t find some field of medicine that I wanted to spend my life in. I was in the final six weeks of med school, looking for an elective that might stimulate my interest. All fields of surgery were full except Orthopedics, so I signed up. All I knew about that service was that the patients either had polio with bony residuals or had broken an extremity and were lying around the hospital in traction or had casts on. The first day of service I was instructed to meet the Resident in charge in what was called the Cast Room at the city-county hospital. That was the location where fractures were diagnosed, and casts applied, or surgery recommended. There was no one there, so I went searching for a nurse. She told me the residents were in surgery and to head up there and forget the Cast Room for now. I found my way to the OR, scrubbed in, and introduced myself as the new med student. I won’t use last names, but Wendell and Jim were working on a fractured hip in a giant of a man. Country music was playing loud, and they were laughing and joking and cussing trying to get screws into a side plate to stabilize the fracture. Jim yelled at me, told me to get my ass over there and put the screws in while they held the pieces of bone in position. I had never seen or done anything like that, but I stepped up to the plate, and did as instructed. It was the most fun I had had in the past four years. I was finally home.

What do you think makes your company stand out? Can you share a story?

I grew up in a good family, with good parents, who taught me values consistent with folks who grow up in a small town in central Texas. My goal in becoming a physician was to help people. I had been around some docs growing up, due to injuries and Rheumatic Fever, and for the most part, they were an unpleasant lot. I always told myself that I could be better than that. So after all those years of training…four years medical school, four years of Orthopedic Residency, one year of Fellowship… I was finally ready to tackle the world on my own. I worked hard to take good care of the patients, to be friendly and kind, treat patients they way I would want to be treated. After a couple of years in practice, and following on the academic train, I was sitting in my office late in the day dictating charts. My secretary walked in, told me there was a patient who showed up late and was insistent on seeing me. Seems she had driven 100 miles to see me and would not take no for an answer. I told the staff to put her in an exam room, get Xrays, and let me know when she was ready. After a time, I went to see the woman. She and her husband were nice and polite, and apologized for being late. Seems she had forgotten my name and lost the directions to the clinic. But the one thing she remembered was that she wanted the doctor who wore cowboy boots because he was the nicest and the best. All those years of training, presenting and publishing papers, and it all came down to cowboy boots. That might have been my greatest compliment.

What advice would you give to other healthcare leaders to help their team to thrive?

I advised my students over the years that we surgeons are there for the patients, not the other way around. And that if a patient feels like they need to be seen, then bring them in and see them. And that if a patient can’t afford to pay a balance after insurance, then write it off. And that the joy of practicing medicine, and the reward you get from that, is to see a happy and grateful patient. And never forget the words of Tim McGraw’s song, “Always Be Humble And Kind.”

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

I can’t say it any better than David Blumenthal for the Atlantic. There are three main reasons that U.S. Health care is ranked low in the world. One, a lack of insurance coverage. Statistics show that insurance coverage lowers mortality. Abut 10% of the population is uninsured, either because they cannot afford it, or don’t have expanded Medicaid in their state, or they are undocumented. Two, administrative inefficiency. Doctors and their staffs waste an incredible amount of time on billing and insurance claims. Different insurance plans cover different treatments and procedures, which forces physicians’ offices to waste time coordinating with insurance companies to provide care. Three, lack of primary care participation. Primary care providers should be, but often are not, part of the team, and should have access to information about their patients from hospitals and specialists, but often do not, in order to provide seamless, coordinated care.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

There are many ideas about changes to improve the health care system. One would be to invest in prevention or better mediation of various diseases. While Diabetes and other chronic diseases cannot be eliminated, better management of its symptoms and complications would save a great deal of money in health care. Smoking is also a source of great costs to the health care system. Smoking mediation or cessation would bring about great cost reduction. Regular physicals exams by the primary care physician would diagnose problems earlier when they are more treatable. Two, assess costs of services and make them more uniform between hospitals with respect to insurance payments. Studies have shown an incredible gap between the cost of, for example, a knee replacement, varying from $16,000 in one state to $62,000 in another. Hospitals should analyze their cost data and share with other facilities. Three, better use of the primary care doctors. They should be the coordinators for patient treatment. I recently spoke with a friend who had a melanoma removed. There was spread into his system requiring chemotherapy. He gave the surgeon a history of some type of skin cancer in the past, but no records at the time were available. Later on, the patient located the previous treating doctor, and it turned out that he had melanoma as a prior diagnosis. Coordination by the primary care doctor could probably have prevented the occurrence, and if not, certainly mitigated the treatment. Four, reduce administrative costs. This could be accomplished by better coordination of insurance companies by providing similar plans covering treatments and procedures. Five, improve insurance coverage. Many people use the ER as the primary care provider. This is a drain on ER staff and finances. Improving insurance coverage would reduce costs as well as deaths. Hard choices would have to be made, however, by expanding Medicaid coverage in the states, or by providing coverage to undocumented families, which is a political hot potato. Universal coverage would probably be a logistical and expensive nightmare, although it does work in other countries. There are many ideas, but few solutions.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

The mental health crisis in this country is primarily due to lack of access to a mental health provider. This is due to several factors, including high cost and insufficient insurance coverage, long waits and limited options, lack of awareness of available services by the affected individual and his or her family, and the social stigma of having sought mental health treatment.

How would you define an “excellent healthcare provider”?

I think the ideal health care provider has changed over the years. Characteristics of the modern provider should be an intense desire to do the job with a good work ethic, excellent professional knowledge, good communication skills, good problem-solving abilities, physically fit, with empathy and compassion for the patients. And believes in the words, Always Be Humble and Kind.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

I have a few phrases that come to mind that fit different occasion in my life. No Good Deed Goes Unpunished. Everything Changes and There Are No Answers. And my go-to phrase, the Tim McGraw song, Always Be Humble and Kind.

Are you working on any exciting new projects now? How do you think that will help people?

I have been retired for 12 years and am writing Doc Brady medical mysteries about an Orthopedic Surgeon in Houston who is an amateur sleuth. I’m trying to entertain readers but try and bring a message home in each novel. The first, Act of Murder, is about Doc Brady solving the hit and run murder of his neighbor’s child. The second, Act of Deception, is about a lawsuit filed against Doc Brady for medical malpractice. The third, which comes out September 10th, is called Act of Revenge, and involves plastic surgeons and insurance companies amidst the breast implant crisis in 1990s Houston.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

These days, I spend my time writing Doc Brady mysteries, playing the piano, and golfing. I was in the healthcare business for thirty years. It was challenging, but I loved it until the insurance companies made it almost impossible to take care of the patient. Repeated pre-approvals, deeply discounted fees, and denials for services gradually pushed me out of the business. I worry about who will go into medicine under the current conditions. Who will take the place of pioneers such as myself, who always put the patients and their needs first?

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

How about a mandatory “get along with your global neighbor” movement? That would make everyone a lot happier and a lot less stressed. You might find yourself liking someone you thought you hated.

How can our readers follow you online?

Thanks much for the opportunity. You can find me at https://johnbishopauthor.com

Thank you so much for these insights! This was so inspiring!