Healthcare Needs a Old Fashioned Country Doctor, Part II of II.

ee) GoodMD_250_II As a result of a hacker attack, this Post from 2/16/09 was deleted. I am now restoring it at the request of a recent new reader who liked Part I and wondered why there was no Part II.

While we have been playing “doctor,” our patient has been getting worse. Previously in Part I, we learned that the patient named healthcare needs a good, old-fashioned country doctor, not a savvy politician, an experienced manager, or Nobel prize-winning economist (certainly not that – anything but that!)

You and I need to remember that ultimately, the politicians, managers, and regulators do what we tell them. Blaming them is avoiding our responsibility and more importantly, blaming solves nothing. WE are the decision-making “doctors” for healthcare and so far, we have collectively been guilty of malpractice. If we really want to make the patient better, WE must become the good doctor and practice effective medicine.

Effective health care for healthcare first requires a diagnosis of WHY. [Healthcare (one word) is a system that provides health care (two words) services to people.] The good doctor – that is us – investigates why, not just what. We cannot depend on what some self-styled expert says is the diagnosis and proper treatment. WE are responsible. WE have to understand. WE have to stop playing the blame game. We have to consider, decide and act.

For decades, our patient (the system) has been deteriorating and now has the following symptoms.

  • 46 million have no health insurance.
  • The average patient experiences 1.14 medication errors each hospital admission.
  • 500, 000 nurse positions are unfilled.
  • Healthcare will consume over $2 trillion this year.

These are symptoms and the good doctor knows that treating them may make the patient feel better (temporarily) but will not make the patient be better. Giving morphine to a headache patient takes away the pain but does not cure the brain tumor. To cure the patient, the good doctor treats cause(s).

There are a number of causes for healthcare sickness but all can be lumped into one over-arching diagnosis: design flaw. The system we have is fundamentally contradictory, bloated, inconsistent, filled with perverse incentives, lacks feedback, and measures the wrong outcomes over the wrong time frame. You cannot patch over, adjust, or fix a system that is designed wrong. You must UPROOT it and replace it with one designed to do what we want and need.

Secretly, we have been hoping for a magic potion, the silver bullet, or an ancient secret witches’ chant, which in today’s world is a catchy new phrase grandly announced on a radio talk show or TV interview by some self-styled expert in healthcare and available in his or her latest book. Do we really think a some simple cutesy phrase can cure healthcare? Please say no! You cannot wave a magic wand and have a new system.

We the people – acting as the good doctor – will never accept a new system imposed on us. We will only accept one we choose. To decide on a new system, we must understand and agree on what the new system will do. Without developing a consensus, there will be only partisan bickering, confusion and contention – the same mess we have now.

In Part I, we asked who is the good doctor and what will she do? The answers are:

  1. WE are the good doctor.
  2. Acting as the good doctor, we accept that the current system is irreparable.
  3. Therefore, we will create a new healthcare system based on guidelines we develop through national dialogue and consensus.

System MD

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