Monday, September 22, 2014

Gunderman on How To Discourage a Doctor

Dr. Richard Gunderman describes the "playbook" of those who wish to control physicians for their own ends. His article was written about what physicians should expect from hospital executives, but it applies just as well to physican relationships with bureaucrats and others seeking to bring medical care under greater government control.

From his piece, "How To Discourage A Doctor":
Merely controlling the purse strings is not enough. To truly seize the reins of medicine, it is necessary to do more, to get into the heads and hearts of physicians. And the way to do this is to show physicians that they are not nearly so important as they think they are.
Physicians have long seen the patient-physician relationship as the very center of the healthcare solar system. As we go forward, they must be made to feel that this relationship is not the sun around which everything else orbits, but rather one of the dimmer peripheral planets, a Neptune or perhaps Uranus...
Hence, those steps include:
  • Make healthcare incomprehensible to physicians.
  • Promote a sense of insecurity among the medical staff.
  • Transform physicians from decision makers to decision implementers.  
  • Subject physicians to escalating productivity expectations.
  • Increase physicians’ responsibility while decreasing their authority.
  • Above all, introduce barriers between physicians and their patients. 
He discusses each point in greater depth in the full article.

Given all this, one way for physicians and patients to best protect themselves is to allow patients to control their own medical spending. This allows doctors to treat the patient as "boss".  Various models such as Health Savings Accounts (for patients) and direct-pay practices (for physicians) work nicely together to protect that vital doctor-patient relationship. 

As Sun Tzu said, "Know Your Enemy".  His advice applies just as well today as it did in ancient China.