WHERE IS THE CHECKLIST?


I have loved health care for as long as I can remember. I cannot imagine doing anything but providing care . What I have learned in the trenches is that the love of providing care is not enough. Over time i have realized that a fundamental problem with health care is not in the expensive of it but in the nature of the people in it. We want to provide care, but we bring into the system our biases. Those biases allow for less attention to be paid to some patients because of their language or skin color. We may say that we provide the same care to all patients, but as a black physician I see otherwise. My experience of the system at institutions where I am not known by members of staff is vastly different. The consequence of this uneven care is a system where those that can afford care and are the correction completion receive care that is more compassionate and timely.

How do we overcome the inherent bias in the system? The answer is not more training nor necessarily more diversity. The answer will be in the wide-spread use of evidence based payment structures. Our medical systems are complicated and expensive but are systems in name only. We have a complex string of components. All the parts are mostly well-trained and competent. However the results we obtain are not commensurate with the level of training nor the level of expense. The incongruity of expense and quality of results continues because those attempting to improve the system have not acknowledged or do not recognize the biases of the system. The gap in quality of outcome is most obvious in communities of color. The often given excuses are truly just that. Recognizing that there is a problem is the first step to a solution.

Paying for quality work is the only avenue to improved results. The question as to how we get better care for all patients is simple and complicated, but we have a great example in the aviation sector. My brother is an airline pilot and his training is extremity rigorous, but he starts his day with a checklist. He does not feel that his autonomy is being challenged, but that he is making sure that he does not kill himself. We in health care do not have any real skin in the game. Until the decision makers have some skin in the game we will not embrace what is necessary to make our constellation of components into a functioning system. Let us start delivering quality care by implementing checklists. Checklists are reminders of the quality in our options. The checklist is not for you it is for your parents and friends. That checklist is not for you, it is for that provider that is on her sixth surgery of the day. It is a nudge because she is tired. A checklist is for every one of us. It helps us by removing silly mistakes from our systems. For me the checklist is my hope that I will be treated like a patient deserving of care on the off-chance that I am a patient in a strange place where all that can be seen is the color of my skin.

DOCTOR, TAKE A STAND.


The debate around health care in our fair country as heated up again. The strange thing about the process is that the majority of the people commenting already have great insurance. They can afford to pay for great health care. The ACA is flawed and all should admit it, but it is not the cause of the chronic underperformance of our system. We have a closed unresponsive system that is constrained by an ill-informed electorate.

We need to exposed the entire system, both strengths and flaws, to the public. Doctors need to be in charge of care decisions and also need to be cognizant of the economic realities. Patients need to have realistic expectations, which should be set by their doctors.

Doctors need to stop listening to the ill-informed lobbyists. Those lobbyists are not working on our behalf, they are working for other economic interests. Doctors need to stand up and start voting our economic interests because the lobbyist are voting for their own. The interests of the lobbyist only rarely intersect with our own.

Let us take a stand together. Let us take a stand firstly for our patients and secondly for our own self interests.

HOW MUCH IS YOUR LIFE WORTH?


The curious nature of the human animal is often a puzzle to me. My single psychology course in college has not prepared me. The current focus on the cost of health care is once such puzzle. As a young physician our cultures disdain for the earnings of doctors is a puzzling. How much is your life worth. Like most young physicians I will be paying my educational debts until I die. So the current trend in American political and social discussion about the value of health care and the cost of a doctor’s services rings hollow. Arguably the value you put on care needed to preserve your life is more than the cost of seeing a concert or going to a nice restaurant. I hope that is the case but it manifestly is not so.
It has become a national sport to complain about how much it cost to get heath care services. This question is lacking in dept and is intellectually dishonest.
We want the best care but are not willing to pay the cost. The cost is directly in proportion to the system we have continued to vote for. We vote people into office that believe that education is a commodity whose cost should be raised to what the market will bear. Once we get to that point we arrange loans to make the needed education attainable. The natural consequence is that the cost of the end product, care delivery, must of necessity increase.
As a physician my debts from education is more than the cost of most mortgage loans and added to that the cost of the eight postgraduate years of lost earnings. The debt burden is heavy and increasingly so. The immorality of telling me to earn less is not lost on me or anyone in my position. The only question from me is, when are you going to start seeing the whole picture?
When are we as a country going to stop asking me to starting earning less. Are you willing to pay off my educational debt? The answer to both questions remains a resounding no. Instead we are sticking to the tired and disproved option of moving care to lower cost providers which generally translate into less educated provider. This is a natural extension of the commodification of health care. As patients we want dedicated care, but we are not willing to pay for it. We would rather spend on a sport or food or anything else. Health care is not french fries. French fries cost nothing, because we as a country have decided to subsidize the production, distribution and sale of potatoes. We have decided to do the opposite for health care and expect a similar result. Until you pay off my first mortgage, please do not comment on how much I earn.