Docs on a Treadmill

“Jaded Julie, there’s something wrong with our title. What is it?”

“It’s not the physicians who are on the treadmill, Curmudge. It’s hamsters or gerbils serving as a metaphor (how do you like that word, Old Guy?) for physicians who are caught up in the excessive demands of their practice.”

“You are correct as usual, Julie. But the thing that really bothers me about the title is that it depicts physicians in an inescapable situation. These people are resourceful and highly intelligent. When I was teaching them as undergrad premeds, they got the A’s in the class.”

“As I see it, anyone—not just a physician—in a difficult job situation has three options: stay and endure it, change the system to relieve their discomfort, or leave. Back on September 3, 2009 in The Evolution of Personalized Care we talked about several things individual physicians and groups have done to reduce the stress and increase the efficiency of their practice. In subsequent postings we described how these innovations were brought together to become the Patient Centered Medical Home.”

“Note, Julie, that most innovations came from physicians in a small group practice (Dr. Burger, the Sinskys, etc.). And in addition, there are many individual improvements in efficiency that are never published. A small group that includes a friend of mine has hired nurse practitioners and implemented an electronic health record. A recently retired pediatrician wrote a book and gave it to all of his patients; this resulted in his having fewer calls from distraught mothers in the middle of the night.”

“Sounds like he was a modern day Dr. Spock. But what about those solo-practice docs who don’t have time to read the literature or the resources to try anything new?”

“They are indeed out there, Julie. The Kane Scrutiny blog recently summarized the findings of a survey of small practices regarding the Patient Centered Medical Home. The respondents’ reservations about operating as a medical home were (in order): lack of money, lack of time, and lack of information about the process involved.”

“The small practices’ responses are a real concern, Curmudge. I’m grateful that the medical home concept is spreading through Affinity’s clinics. Physicians and staff that I have talked with in our pilot clinics are enthusiastic about it, and it will help us bring personalized care to more and more of our patients.”

“Have you thought about the physicians in other large organizations, Julie? If they feel that they are stuck on a treadmill, there’s not a lot they can do to change the process. It’s pretty hard to initiate changes from the middle of any organization, and it’s especially difficult if the organization is very large and extremely hierarchical. The options there would seem to be either stay or leave.”

“The military is about the largest and most hierarchical outfit that I can think of, Curmudge. All too often physicians leave when they have fulfilled the active duty obligation they incurred when they accepted a scholarship to medical school. One career Army doc that I know transferred from a hospital to an infantry battalion. So, Rambling Writer, what’s the bottom line of this discussion?”

“In most situations, primary care is not binary, Jaded Julie. It’s not simply good in a medical home and bad if it is delivered by a doc on a treadmill. There are lots of variations in between provided by physicians who have devised ways to make their practice more efficient. Of course, in my opinion the medical home concept is the best. Here it is, summarized in the Kane Scrutiny:

‘The PCMH concept calls for physician practices to develop a team approach for caring for patients; use evidence-based practices; coordinate patient care; utilize performance measurement and quality improvement; adopt health information technology, and track patients and results.’

As the automobile salesman used to say, ‘You can’t do better than that, now can you?’”

Affinity’s Kaizen Curmudgeon