“The purpose of health care is to provide health care. And...the more we can focus on that, the more we can leverage the hope that I do think that we have,” says Colin P. West, MD, PhD.
In this installment of “Begin Your Journey,” Colin P. West, MD, PhD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about why thinks there’s hope for the future with alleviating health care provider burnout. West is a professor of biostatistics, medical education, and medicine at Mayo Clinic in Rochester, Minnesota. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.
MacDiarmid: I was stuck myself in not accepting the system as it currently is, and that led to bitterness and resentment. I liked what you said about writing it down; I actually wrote down what is it that's bothering me the most. I also wrote down the main drivers, and with baby steps, address those. Even baby steps on large drivers can make a big difference, and it really is something I urge our surgeon and physician friends [to try]; it's a good exercise. I used a soapbox a lot, not as much as I used to, and one of my targets would have been the health care system, the hospital systems, and the CEOs, not to personalize it. We've got these mammoth health care systems, and then they've employed all the providers. I'd like to point the finger at them, in a sense, as part of the commoditization of the health care system. Are they trying to help us? Are they willing to help us? Do we have hope?
West: The short answer is, yes, we have hope. But I don't want to be a Pollyanna here and suggest that this is going to happen without continued attention and effort. Our health care system has many barriers that have, I think, worsened since we've started heading down this path toward commoditization of medicine. And what that really serves to affect is that the primary element in health care is at risk of not being that patient-physician relationship. We start feeling like we're serving the clock, we start feeling like we're serving the billing code, the [relative value units], the volumes, all of those sorts of things. And that's because there's a business behind the scenes. One of the main tensions is that, although that business behind the scenes is a reality, we as individual physicians, in the moment, in our one-on-one interactions with patients and their families, don't really want to be thinking about that, because it's a separate sort of thing. And it's not what drives meaning, values, or purpose. What we really need is for these organized aspects of medicine to be able to say, okay, yes, there's a business aspect that goes behind this, because medicine is involved with expenses, and health care is a big part of our GDP. We don't get the outcomes in the US that we should from that investment. That's a product of how we've set up our infrastructure. But we need people, administrative types, to be partners in this where they can manage the ship, and think about in their management decisions, how those decisions elevate and hold sacred that patient-physician relationship. I think that's the piece that when it gets lost, contributes to a lot of distress, a lot of people feeling like, "Well, where is the hope in this?" But when we start flipping that around and saying, wait a minute, the business part becomes secondary, the electronic medical record become secondary in the office. It serves your relationship and your care for your patient, as opposed to feeling like we serve the computer and the patient is almost a nuisance in the room, distracting us from our data entry. I'm saying that with a smile on my face, but it's going to ring true to a lot of us in parts of our day. The more we can shift away and say, our tools, our business elements, our organizational structures are there to help us connect with patients, the more they can actually turn the ship in the right direction. That requires all of us demanding it. And it requires that all of our leaders in health care embrace this idea of what I call enlightened leadership, where they understand that the purpose of health care is not primarily to make money. The purpose of health care is to provide health care. And yes, the more we can focus on that, the more we can leverage the hope that I do think that we have. It's going to take people like you and me and advocates in major organizations and societies accepting nothing less, quite frankly.
This transcription was edited for clarity.