Health Care: providers are more important than patients

Bear with me, I am not a very good writer. But I am teachable so will hopefully improve as I do more writing.

Health care is a multi-faceted, complex space. It has been getting a lot more attention of late and from some very important people I might add. This is all good. The more people engaged in the issues of health care the better.

However, I want to mention one really important caveat. Providers need to be the center of attention when it comes to fixing health care. Not patients! I know (if anyone reads this) the likely readers of this blog will be patient-centric folks. And I also know that those words just written are anathema to them. Good. I want people to think and think very hard about the trajectory of reforms, changes, fixes and course corrections in health care. I will explain my rationale too.

Disclaimer:
Let me be clear, nothing about the broad descriptions of providers and health care should be construed as an attempt by me to glorify them or deny the reality that there are glaring issues, problems and failures in health care and that providers are in part to blame.

For starters, providers have all been patients but patients have not all been providers. Why should that matter? Perspective matters. Maybe kind of like @msuster. He has been on "Both Sides of the Table" in the VC world and it gives him a better perspective. I'll concede that this might be a minor point. But worth making.

Here's a major point, to me anyway. All providers have a duty from a combination of moral, ethical and legal confines to make the patients for whom they care the center and primary focus of their lifes work. Many also have an intrinsic, life-calling, mission to care for patients as well. I have had countless encounters with "newbies" in health care who tell me they are pursuing their career because, "I want to help people." This is something that is found in few other places and cannot be minimized in the least. Okay, addendum to disclaimer, I know there are providers who operate under none of those constructs rather, for their own selfish ends. However, here, as an example of the norm, is a link to a video (http://bit.ly/uV5Akc), which is a little long, where you hear first hand from someone who chose to protect patient's interests to the peril of his own career, on more than one occasion. Yet, he ultimately became very successful (for himself and millions of patients around the world). It is a great lesson, for us all. Chose to do the right thing, always, and success will follow.

Another very important issue, the education infrastructure for providers in this country is second to none. There are hundreds of thousands of great professors, instructors and teachers who provide the educational backbone for the medical professionals coming into the market place. I can think of many in my education who were not only exceedingly bright but were dedicated and "called" to do what they were doing. These that make our educations fun and exciting are an incredible asset, ultimately to patients.

Similar to and part and parcel to the educational system is the research system in this country. Part of what prompted me to write this blog was the posts I get in my twitter feed from @Life_Sciences. I don't read all the articles. Who could? But I read most of their tweets. It is impressive, to say the least, the volume of research going on. Also impressive, the nuance and granularity of research going on. Here are a couple of titles for you, meant to impress:

Targeting PDGFR-β in Cholangiocarcinoma

Results of carbon ion radiotherapy for skin carcinomas in 45 patients

Immunohistological pointers to a possible role for excessive cathelicidin (LL-37) expression by apocrine sweat glands in the pathogenesis of hidradenitis suppurativa/acne inversa

These are just the last three tweets from @Life_Sciences

So what is my point in all this? How does this diatribe conclude to supplant the focus from patients to providers? Alas, I have to drone on a little more. I know we (providers) are the ones you (patients) see when your appointment time got screwed up, your lab results didn't get sent to the hospital in time for your surgery or you had to wait 2 hours past your scheduled procedure time. But we are not your enemy! I can't say that emphatically enough. And I know that you know that. However, there is a tone in the patient centered movement that puts us at odds with you. This should go away immediately. Emblematic of this were the comments I heard from the CEO of a startup EMR provider at the Health 2.o conference in San Fran last October. The gist was that no matter whether we (providers) liked it or not we were going to have to adopt the technology that was being given to us by companies like his (I graciously am omitting the name of this CEO and company). And I have heard variations of this theme my whole career, "whether you like it or not!" It is a dangerous and destructive mindset. And it is a big reason we are in the situation we are in. Providers are your allies. We dedicate our lives, many times in a meat-grinder of circumstances to learn how to give you good medical care. We are bright, educated, dedicated, disciplined and altruistic. Who would stay up 24, 36 or 48 hours in a row to learn how to be an engineer? But then when we need tools to do our jobs more efficiently, safely, humanely, mercifully... we are told, "you'll take this and use it no matter whether you like it." We don't like and resist adopting dumb, broken, old, ineffective, obstructive, (insert descriptor) technology, tools or processes. Suffice to say, for many reasons - which will be another post, there is a huge, gigantic, epic disconnect between those of us doing direct patient care and those building the tools of technology we need to help us do our jobs. I was at the Healthcamp conference prior to Health 2.0, the un-conference, where the participants could create the breakout session topics. I put up my little sign for a session titled, "Take your developer to work day" in order to help explain the divide between developers, hackers and coders with the providers. Result - insert audio of crickets chirping. Not to sound elite, rather realistic, too few know what we do, how we do it and why we do what we do. This is why I gave the background info of the life path, educational and research paradigms. Health care is a world unique to all others for many reasons. The players who have not been leveraged (sorry for the catchy and overused word) are providers! Quite the contrary. We are suffering from autonomy and calling deprivation. No profession with the background of training and dedication has been leaned on as much as health care providers. We have some of the worst systems in which to do our jobs yet still find ways to give excellent care to millions of patients, keeping them safe and helping them get well. Sure there are problems (more disclaimer) and those are all well known - thanks a lot Michael Moore. By the way, when was the last time Michael Moore was healthy? I'll buy you a treadmill and a copy of "The 30 minute Vegan" cookbook and trade you that for your health insurance - but I digress, yet another post to write.

I emailed Fred Wilson, after his post about health care. I told him an analogy a colleague of mine recently used with a patient of his. We (providers) are taking care of sick patients, most of whom are suffering diseases from lifestyle choices (still another post topic) in a broken system. Yet we are responsible for an exponentially increasing complexity of knowledge and are expected to do our jobs flawlessly. It is like asking a pilot (the patient to whom my colleague was speaking) to fly a broken plane. The pilot would never do that. The system is broken, patients are broken and we have to fix them in a snapshot of time. Where's the sense in that?

Engage providers with real tools that work. Tools that don't become an end unto themselves - i.e. Government mandates, core measures, JCAHO accreditation, CMS guidelines, ICD-10, EMRs of all varieties, etc. Use the same business model of the current raging, hot fire of social networks - users (providers) are the value! I have said this before (no offense to Foursquare) and will say it again. It may be cool to be the mayor of a Starbucks in Palo Alto but having cancer sucks. If you understand the background of why that statement resonates then you are starting to understand the world we live in. There is technology out there that makes what we use in our daily lives seem laughable. It would be like playing pong next to someone playing Call of Duty on the PS3. I am not exaggerating. If you think I am then come with me to work some day. I will make that happen tomorrow!

Providers should be the primary focus in anyone's thesis for how to engage in the health care space. If we have help in improving the way we do what we do then you (patients) will directly benefit. You will get what you want - better care, cheaper price tag! To me, it's a no brainer!