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Beyond 7 minutes

I trained as a Family Doctor so that I would be ready to help patients with any challenge. The old school family doc used to take that skill set out into the community on house calls, sports sidelines, and town hall meetings. At some point the job description was boiled down into a job that started and ended with a 7 minute office visit. That setup is not good for patients, and it's not good for doctors. In this column I hope to start to push the boundary of where the doctor patient interaction takes place - onto the page, into the community, and beyond 7 minutes.

Doctors and Patients Unite!

As a doctor who has dedicated a career to primary care and public health I have more than a strong feeling that our health care system is heading towards change—and soon. Costs are too high, patients are too sick, and doctors are too burnt out to keep going on the current track. History has shown that systemic change often comes in fits and starts. But when change comes, it can be revolutionary.

Since the passing of the ACA in 2010 the health care system has been fairly stagnant in terms of systemic change. This is not for a lack of effort. In different ways patients, doctors, employers, and health care systems have been advocating for change. But these efforts do not always align. In theory different groups all say they support the quadruple aim of better care, lower costs, higher patient satisfaction, less physician burnout. However, when the rubber meets the road there is not much agreement on how to do this.

Unfortunately, stasis and lack of change has led to conflict between different groups. Doctors feel trapped in a health care system that doesn’t appreciate them. Patients feel like the health care system has left them out to dry medically and financially. Health care systems feel the squeeze of competition and financial viability.

We are led to believe that this is a zero-sum equation with winners and losers. What if the solution to our health care conundrum doesn’t have to pick winners and losers?

LOCAL GROUPS FOR CHANGE

Outside my day-to-day practice as a family doctor I have become involved with two non-profit groups working towards change. The first is the Southern Maine Workers’ Center, which has a “health care is a human right” committee.

This grassroots organization has brought together working-class folks from all over Maine to discuss the path towards systemic change. The group–which anyone can join—has a public list of priorities which they formulated through democratic process.

A free health clinic offered by Southern Maine Workers’ Center (SMWC) and Maine State Nurses Association in 2014. -WEN file photo courtesy of SMWC

Another group with similar but separate aims is Maine All Care. This group is affiliated with Physicians for a National Health Plan and is made up mostly of doctors, but non-doctors are welcome too. They advocate for a universal single-payer system and have been working legislatively and regionally for years to accomplish this.

UNITING DISPARATE CONCERNS

It is possible that in working towards change separately we may deepen the divide between doctor and patient. I have seen doctors get lumped in with big health care systems as “part of the problem.” While it is true that many (but not all) doctors are employed by large health systems this does not mean that we are beholden to them.

On the other hand, many of my physician colleagues have expressed frustration with their jobs, and by proxy their patients, due to unreasonable demands on their time and job description. Even the most caring doctor may misattribute a patient “no show” or a medical “non-adherence” as the fault of the patient rather than the fault of the system.

If we are going to change health care for the better, doctors and patients must get on the same page about what the future of health care will look like.

The patient is in the position to explain the experience from the consumer perspective. What do they value and don’t they value? What is a reasonable cost? And practical things like how much time they want and need to feel heard?

Doctors are on the front line of delivering that care, which means they have firsthand experience on the science and practice on what improves health and happiness. They are also the ones who order the tests and medications, which cost money. Making prices transparent to doctors and patients would be one of the best and easiest ways to bring down cost.

SUSTAINABLE HEALTH CARE FUTURE

I fear that at the current trajectory the impending health care revolution will lead to compromises that will either be impractical, un-sustainable, or more expensive than what we have now. If patients win their demands but the doctors are not on board, who will provide the care? If doctors win their demands and they do not line up with what people want and need, are we better off than we are now?

It is only by delving into the details at the most granular level that we can give ourselves the best chance of winning the sustainable and lasting changes we deserve.

Oren Gersten, MD