Physician Heal Thyself – Enhanced Role for Physicians as Trusted Advisors

09 May Physician Heal Thyself – Enhanced Role for Physicians as Trusted Advisors

Healing (hēl ng) v.
  1. To restore to health or soundness; cure.
  2. To set right; repair.
  3. To restore (a person) to wholeness.

I previously highlighted a recent study by Booz Allen Hamilton regarding the Consumer Empowered movement and physician responses to it. I thought the physician responses were very both unfortunate and very telling:

  • Positive Impact of Consumerism (from physician perspective)
    • 90% expect to see an increase in CDH plans over the next 5 years
    • 70% believe CDH will lead to greater attention to level of service
    • 55% consider CDH to be an enduring trend
    • >50% believe CDH will lead to greater attention to clinical quality
    • Less than 20% believe that increased consumerism will improve results
    • Believe that CDH wil most positively impact employers, plans, and patients the most benefit
  • Negative Impact of Consumerism (from physician perspective)
    • 84% believe CDH will lead to greater attention to health care costs
    • 69% believe that patients will have increased difficulty paying their bills
    • 58% believe it will negatively impact patients (self-rationing)
    • 40% believe that CDH will most negatively impact physicians, pharma, and hospitals
    • 25% see consumer-directed health-care forcing them to lower their prices
  • Quality of Service
    • 80% believe that they currently compete on the basis of personalization of service. ~19% currently make safety and medical error rates publicly known
    • 60% believe that they currently compete for patients based on clinical quality

So while physicians see the consumer movement starting to become more and more prominent in their practice, I don’t see a concomitant response to take advantage of it – or even recognize how they are going to have to shift their practices to adjust to a new type of relationship with their patients. Psst, Dr. Mayberry, you are not practicing in Kansas anymore.

The Booz analysis from the study was right on: “Despite the potential impact of consumer-directed health-care on their practices, many physicians do not appear to see their future role or behavior changing dramatically. There is a gap between consumer demands and what many providers are preparing to deliver while some consumers are beginning to act like true retail buyers and shop for value, many physicians are not responding to consumer demands for additional information, more competition, and an enhanced advisory role.

It is disappointing to not see the physicians reacting or adapting to this new movement. While clearly there are some exceptions, it is reminiscent of the whole insurance industry absconding with the physician reimbursement process in the early 80’s (the mid 60’s to the mid 80’s are often referred to as the “Golden Era of Medicine” because physicians were able to essentially dictate their prices and were reimbursed fully). I was trained by all of these doctors, and their pessimism and often seething anger at how things had changed was palpable. So much so, in fact, that I chose to use my medical degree as a platform, instead of a profession.

However, “change they must” if they want to compete for patients in the future. In a industry that is redefining itself, the physicians have a unique opportunity to get engaged and lead the way. But it won’t necessarily be in front, like it has in the past, but rather side by side with the patient. You see, in the brave new world, the patient becomes front, center, and the focal point of the medical interaction. The physician will be either an expert knowledge aggregator, a skilled practitioner, or a trusted health advisor (or some combination thereof):

1. Knowledge Aggregator. Patients have just as much access as information as the physicians, and because they have more time and a much more narrow focus (their specific problem), they can often rival the physician in finding information. The challenge, of course, is to make heads or tails of the information that is gathered. Patients often know only enough to be dangerous. I have seen how this can create confusion and conflict as patients demand treatments that may not be appropriate and wave a print out from a Google search in your face. However, the physicians need to understand that dynamics are changing, and that they will need to meet patients at the forefront of medical information and serve as a aggregator of quality information as well as a translator by putting things in correct context. Informed consumers will create more urgency for physicians to stay current and be aware of a plethora of information sources now available (including using RSS feeds from journals, tapping into blogosphere, and patient communities).

2. Skilled Practitioner. The role for physicians in terms of physical interventions is not going away soon. While there is some promise in robotic surgery, we are still a long ways away from a computer replacing the human touch in surgery. But it does highlight the need for physicians to improve their “skills”
of prevention (through mining of patient databases with analytic tools that proactively look for health or financial intervention opportunities; ie, this patient is on lipitor they could be on generic X or its been six months since their last live test), diagnosis (through innovative, automated disease diagnosis tools), medical therapy (leveraging evidence based best practices) or surgical treatment (with published outcomes on improvements in quality of life, infection rates, and costs). In the new era of transparency, the term “skilled” practitioner will be an objective adjective bestowed by virtue of hard evidence rather then granted by reputation alone.

3. Trusted Advisor. Putting this all together, the ongoing and unchanging role will be that of a trusted advisor. One who has your best interest at heart, one who counsels you, one who has the experience, and one who truly cares about YOU, and knows you well enough to understand your own personal context. This type of trusted advisor relationship can not develop in a “hurried 15 minutes take your Rx and good riddance” type of encounter (the rise of “retail clinics” is a different phenomenon [which I will discuss later]). For this reason, the entire concierge medicine market is flourishing which is really a manifestation of the “trusted advisor” concept in the extreme. To become a trusted advisor requires clinical excellence, properly aligned incentives, and demonstrated value (outcome/price) over time.

In this new age of medicine, the physicians who understand their role as trusted advisors may be the only ones who are able to preserve the societal perception of physicians as healers.

6 Comments
  • Vijay Goel, M.D.
    Posted at 03:55h, 16 May Reply

    Scott,
    I share your frustration with getting the average physician to take advantage of consumerism in creating new business models for care. However, those models are forming with early adopters (cash pay practices, concierge medicine, cosmetic medicine) and as they gain scale and show profitability the average physician will change as well.

    We only need the early adopters to start to see advantage. From there, the rest will move as they begin to envy their more successful colleagues.

  • Scott Shreeve, MD
    Posted at 04:40h, 16 May Reply

    Vijay – well said. Perhaps I am too far out on the curve and need to let things work themselves out. I guess the impatience has to do with the size of the opportunity and the scale of the potential impact of adopting consumerism in practice.

    Please send me any examples of those early adopters and what they are doing to take full advantage of this movement.

  • Vijay Goel, M.D.
    Posted at 03:21h, 17 May Reply

    Scott,
    Check out the benefits cited by MDVIP about their concierge doctor services:

    Doctors give their cell phone and beeper to patients, wellness plans are developed, PHRs, more extensive physicals.

    Link is: http://mdvip.com/NewCorpWebSite/Physicians/DoctorReasonsToSwitch.aspx

  • Anonymous
    Posted at 23:56h, 26 June Reply

    Excuse me, why should I take advantage of consumerism and compete even more with my colleagues based on cheap prices? Reading that alone I assume that you are not in private practice and that you either do not practice medicine and / or do not do your own billing. I should submit to more competition? Work for less? Is that what you are saying? I should lower my prices to get more patients? Shold that really be the focus of consumerism in medicine, then it is just the same disastrous nonsense of the 80’s in another color. Back then they promised to get us more patients if we just accepted to charge less per patient. And soon everybody wa spaying less and we had to work more and more for the same money.
    Sure, it is a business, and we have competition, but do you have to push it? On whose side are you?
    No, thank you, count me out.

  • Scott Shreeve, MD
    Posted at 06:13h, 27 June Reply

    Anony(mouse),

    I appreciate your comment. I am sorry you missed my point about health care “value” being something that people are more than happy to pay for. If consumerism is only about price – count me out to.

    I believe consumerism is about choice (and informed decision making), and that the physicians who provide the most value (outcomes/price) will have benefit the most. I believe that physicians should be able to charge whatever the market will bear and whatever their personal reputations will support. Unfortunately, there is no health care market and there is no basis to judge a physician’s reputation other than his interactions with patients.

    You see, Dr. Anony(mouse), in the brave new world you WILL be subject to more competition – but it won’t just be price – you will be competing for patients based on your quality scores, your outcomes results, and your ability to deliver improve health to your patients. It will all be transparently displayed for your consumer patients to see and to choose.

    I hope you are the type of physician who can command a significant market premium on your services because you can deliver on all of the above.

    And, oh by the way, I am not on your “side” – I will be kicking your rear to help you get to where you need to be in the new age of patient centric care. Best wishes.

  • Richard Hill
    Posted at 20:47h, 10 January Reply

    Good Luck!

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