An Unvarnished View of How Physicians Can Adapt to Health Reform

It is not the strongest of the species that survive, nor the most intelligent that survives. It is the one that is most adaptable to change.
Evolutionary theory

September 23, 2011- Two events of yesterday shape this blog.

One, a invitation to speak next May before the Physicians Insurance Association of America (PIAA) about how to adapt to health reform pressures along with the title for my talk.

Two reading a book written by two intellectual elites – Thomas Friedman of the New York Times and Michael Mandelbaum of Johns Hopkins School of Advanced International Studies – authors of That Used to Be Us: How America Fell Behind in the World and How We Can Come Back. (Farrar, Straus and Giroux, 2011).

Tentative Title

My tentative title for my talk is “An Unvarnished View of How Physicians Can Adapt to Health Reform." The title is tentative for good reasons. It’s a long time, eight months- between now and when I’m scheduled to give the talk. A lot could happen in the interim, like a Supreme Court decision on the constitutionality of the PPACA, aka Obamacare, the give-and-take of the presidential campaign, and a double-dip recession.

But, as Friedman and Mandelbaum say in their book, four major challenges will still exist for America, how to adapt to globalization, how to adjust to the information technology (IT) revolution, how to cope with growing demands on government, and how to manage a world of rising energy consumption and climate threats. This challenges apply to physicians as well.

As a physician organization, the Physician Insurance Association of America, whose sister companies in various states offer malpractice coverage for the majority of American physicians, is concerned with the health reform law and its failure to address the issue of tort reform and its enormous impact of costs, not only through rising malpractice premiums buy through the common practice of “defensive medicine” to avoid future malpractice suit.

John E. McDonough, A Democratic insider and an unabashed admirer of the Health Reform law, just wrote a book Inside National Health Reform (2011). I reviewed it in my last blog. Nowhere in the book does McDonough even mention national tort reform. This means, I suppose, that either the Democratic party is a captive of the National Trial Lawyers Association, or it considers malpractice costs as inconsequential.

With regard to tort reform, my advice, and the best advice in my opinion, is to give no advice, is to follow the advice of Donald J. Palmisano, MD JD, founder and CEO of Intrepid Resources (R), a risk management and patient safety firm, who says in his book On Leadership (2011): Lead on tort reform, do your homework on its true costs, have the courage to highlight it at every opportunity, persist in your efforts to reform the legal system, be decisive in your beliefs and communicate those beliefs in every forum you can find (On Leadership: Essential Principles for Business, Political, and Personal Success), SkyHorse Publishing, 2011).

As we take the lead on tort reform , however, we physicians must keep in mind that globalization, IT, and debt forces are irrevocable and inevitable. We live in a competitive global economy, the fastest growing debt component is Medicare and Medicaid, and IT is profoundly effecting the practice of medicine, which will never return to the way it was before the health reform law passed on March 23, 2010.

As evidence of globalization, I would point out that 25% of our physician workforce is already foreign trained or born, that offshore care for high tech procedures is growing rapidly, and that international use of personal computers, cloud computing, and social networking already interconnect and empower us all.

As for IT transformation, physicians should take a leadership role. We should point out that Google self diagnosis has its pitfalls (“A little knowledge is a dangerous thing); that most Electronic health records are not ready for prime-time (most do not even talk to one another , are prohibitively expensive , slow productivity, and change the fundamental nature of medical practice).

As the same time, we should be honest ( IBM’s Watson, for example, can facilitate diagnosis, particularly of rare disease or in resolving difficult diagnostic problems with multiple treatment options).

In addition, we should be constructive in offering suggestions to improve EHRs. For example, we should encourage the inclusion of speech recognition in EHRs; we should foster the idea of Narrative Science, a fledging field in which masses of data are translated into narratives; and we should promote the idea of the Instant Medical History, wherein patients rather than doctors or medical staff enter their demographic, drug histories, allergies, clinical symptoms, and chief complaints before they enter the exam room on their home computers.

Tweet: Physicians should continue to lead on tort reform and start to offer constructive suggestions on how to improve electronic records.