One of my patients was discussing the notion of administrative bureaucracy in medicine. He asked me if I thought the increasing number of regulations was related to a lack of common sense in medicine. I initially responded in the negative, but as I considered the question more, I realized that common sense has, unfortunately, not significantly factored in the practice and economics of medicine.
My patient was shocked, for example, to learn that while the U.S. outspends every other country on healthcare, we are not even in the top 10 in terms of outcomes. This realization has informed the healthcare reform debate, but has not led to as much change as we need. My patient would likely be even more shocked by other aspects of the U.S. healthcare structure:
• It is easier for me to get a complex heart surgery paid for than nutrition services for at-risk patients.
• Even in an era of healthcare reform, our hospital system is still losing money by improving the quality and cost of care.
• We continue to spend tremendous amounts of money at the end of life —even when data suggests that if patients understood what they were getting, they’d decline it.
• With each new regulation, my ability to connect with patients is compromised just a little bit more.
• I spend more time documenting than any other activity, including talking to patients and conducting physical exams.
As a physician who splits her time between administrative leadership and clinical medicine, I have a unique perspective on the intersection between the clinical and business side of medicine. My patient asked what I do in my new role as medical director. I explained that my job was to articulate what happens in the exam room to those who do not see patients, so others can understand how decisions they make impact the patient and their care team. What I didn’t discuss was that the other part of my job is to explain the administrative leadership decisions to my physician colleagues in a way that reassures them that we really are all in this together.
The clinical and administrative sides battle on a daily basis. Government regulations are one attempt to infuse some reasonableness into how medicine is practiced. Not surprisingly, those regulations do not reliably bring about positive change. However, we all recognize that things should not continue as they are —where we spend a ton of money to get a second-rate product.
My hope lies not in the regulations or even the promise of common sense. Instead, I find it in the people with whom I work —both the clinical and administrative folks. I have yet to find one who does not care about the patient. While we may disagree about how to provide the best care or even what the “best” care is, I am confident that as long as we continue to focus on what happens in the exam room, we will be moving in a positive direction.