4 Big Questions Physicians Must Ask Themselves
The following is adapted from Healer, Leader, Partner by Jack Cochran
As physicians, we are trained to diagnose and treat disease and relieve suffering.
We dedicate ourselves, through rigorous training, to search for cures and perfect treatments and procedures to restore the health and wellness of our patients.
Over the past few decades, we have made major progress from improvements, to miracles, and even cures. But our work is not done, and it needs to improve as patients still experience uneven quality, access, and affordability.
We must be open enough to recognize these needs that extend beyond the basic clinical responsibility, and committed enough to accept a broader sense of responsibility to our patients. This means asking ourselves four questions.
1. Is Excellent Good Enough?
It seems clear that our interpretation of what is excellent today is not good enough for the future. Major progress has dramatically improved care with two deadly diseases:
- Heart disease: According to the American Heart Association, the annual death rate attributable to coronary heart disease declined 35.5% from 2004 to 2014.
- Cancer: The American Cancer Society reported the cancer death rate declined 25% from 1991 to 2005 (from 250 deaths per 100,000 people down to 161.)
Despite these results, we continue to struggle with uneven quality results, inequity, problems with access, and a growing challenge with affordability.
We also see disturbing trends in obesity, addiction, and violence.
It is startling that medical error is still the third-leading cause of death in the United States, surpassed only by heart disease and cancer, respectively.
On top of that, medical bills are the number two cause of bankruptcy for families in the U.S. Families are not waiting for the ideal legislation or the perfect insurance plan.
All they want is affordable access to safe care.
This leaves us to answer the question, “Is excellent good enough?”
2. What Kind of Ancestors Will We Be?
Dr. Jonas Salk once said, “Our greatest responsibility is to be good ancestors.”
This question is a rephrasing of that famous quote. How will our descendants view us?
When I started practicing as a surgeon, health care costs were 10% of our GDP, and they are now 18%. During this time, I’ve tried to deliver quality care in a compassionate and caring manner. I’ve also prospered professionally, personally, and financially.
But what about my twelve-year-old grandson, Taylor?
He will inherit an obligation for my Medicare and Social Security from my large generation of baby boomers. That 18% figure will likely go up during his life.
This wealth transfer will have a huge impact on the average American family. Families want to care for themselves, and health care is a major issue. As the cost of monthly health insurance premiums continues to rise, one adaptive behavior for families is choosing coverage with a higher deductible, betting they will never have to pay it.
Unfortunately, this is a gamble that, if lost, could amount to thousands of dollars of unexpected costs when there is unexpected illness or an accident.
Because of this, average families are forced to ration health care every month.
It is common for a family to be facing competing needs for an MRI, paid out of pocket, and a new clutch on a truck that is needed for a parent to work, or an elective procedure versus a new refrigerator. Many families don’t have this discretionary family budget readily available anyway, so they opt for deferral, difficult decisions, or credit cards.
Contrast these realities with the reality of physicians. On the one hand, we have the trust of patients to give the right advice and deliver the right care safely.
The decisions to deliver care are still made mostly by patients and their physicians; up to eighty-three cents of every dollar is still spent on health care directly.
As a group, we have a concerning number of physicians who are burned out or disillusioned at this time when we are needed to lead the charge.
Therefore, we must include a strong commitment to learning how to address the issues that are negatively impacting a growing number of unhappy physicians.
3. How Big Is Our Ambition?
Over the past several decades of medical advances, we have been able to deliver wonderful care to relieve many patients through some very challenging times.
And yet, we have some real problems inside the house of medicine that are challenging not only us, but also vulnerable individuals with families and with many responsibilities.
It is obvious that the current system is not optimal. Can we reasonably trust this system will be corrected by the status quo and others with no clinical awareness?
Despite a physician cohort that is unhappy and some that are even disillusioned, we must never forget that honored covenant we have with patients.
The role of patient is involuntary, and they need us more than ever.
As healers, we must always be focused on outstanding clinical care delivery, as that is our platform of credibility from which we can embrace being compassionate, patient-centered leaders who boldly commit to transforming our health care system.
Patients encounter the health care system physically, socially, psychologically, and financially. In addition to being a superb physician clinically in any specialty, we must embrace the roles of healer, leader, and partner because these roles combine to fully acknowledge and support the complexity of the patient’s reality.
We need to change this trend and create an inflection point where all the impacts of health care begin to align in a positive direction with the needs of our patients and families. People are still having trouble with this system, and we’ve got to stop that trend and work toward improving access and affordability.
If health care impacts a family in ten ways, and six of them are positive and four of them are negative, physicians have got to create an inflection point so that we are not only solving individual clinical issues but also the totality of the problems patients have encountering the health care system. That is the inflection point.
4. How Broad Is Our Sense of Personal Mission?
We must commit to collaboration with other organizations including direct competitors to find solutions for the entire community beyond our organization.
The dilemma we must face is examining the scope of our responsibility. Does it include simply our patients, or should our scope be expanded to the entire community?
This forces us to examine the place of competition versus collaboration expressed as keeping competitive advantages to ourselves, rather than embracing collaboration and generous sharing with competitors to drive improvement in the greater community.
A good example of a grassroots learning coalition movement is the Choosing Wisely campaign originated by the American Board of Internal Medicine. It’s been expanded by a broad coalition of learning organizations that continue to work together to advance the best science to make the most sensible decisions in selecting care options.
A great example of community collaboration is the work done by the multiple major hospitals in the city of London around stroke care. The decision to develop a national stroke strategy was made, and a process was completed that changed the model from an open referral system to thirty-two hospitals, to a focused and resourced system of eight hyper stroke units with more robust resources and capabilities.
The results for stroke patients continue to demonstrate improved outcomes, including fewer complications and deaths and better functional results. This very intentional process meant that many hospitals no longer delivered this kind of care to create a better outcome for the community at large. This is hard work but it’s essential.
For more advice on the role of physicians in the changing world of healthcare, you can find Healer, Leader, Partner on Amazon.
Dr. Jack Cochran practiced plastic surgery in Denver for ten years before moving to Kaiser Permanente Colorado to establish their plastic surgery program. He served St. Joseph Hospital as a member of the hospital board and as medical staff president. Repeatedly named on Modern Healthcare’s list of influential physician executives, Dr. Cochran worked extensively with national health policy development, including working with The White House and United States Congress, and spoke globally about integrated care, innovation, quality improvement, and physician leadership.
