Saturday, July 21, 2012

London,  Pride of Lions, and Health Reform  on My Mind

Let your mind alone.
Title of book by James Thurber (1894-1961)
July 21, 2012 -  I have London on my mind.  The London Olympics are coming up in a week or so.   Occasionally I read about the English health system and how the  British government proposes to turn the system over to general practitioners to run and how a multiyear years study of pay-for-performance bonuses to practitioners for treating hypertension did not change outcomes one little bit. 
I wonder how things have changed in London.   I wrote the following  in my 1988 book And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota (Media Medicus, Minneapolis).  
As I re-read this passage from my book, I thought of that old bromide:  The more things change, the more they remain the same.  Government and management experts still think they know more about the practice of medicine than doctors:   consolidation into large  organizations is continuing;  and only way to fight organizations is to fight fire with fire – form organizations of your own.
"The dominant British symbol is the lion. You see lions, or their mythical cousins, the griffins on everything; the royal seal, Welsh and Scottish flags, the coat of arms of the city of London, pedestals in front of buildings, and at the bases for statutes.  If you have any class or clout in England, and you want to be a roaring success, you flaunt your lions."
"Lions symbolize pride.  Why else would you  call a group of lions “a pride of lions"? And the phrase “lion-hearted” conveys a particularly heart-felt pride. 

In any event, the leap in my mind was short from lions to American physicians, who were, until recently, members of a proud profession. "
"I shall focus a bit on pride, control, and influence of physicians on the American health system."
"We American physicians are beset, besieged, and bewildered by the transition  from a cottage industry of autonomous physicians to  a giant $ trillion health industry beyond our control. Competitive forces  have created forces of consolidation and complexity that confound us. Cynics predict American physicians, being poor businessmen and managers, will not adjust to their changing environment; that they will be captured by businessmen or become victims of their own managers, and that genetically and by training they do not possess the skills necessary to become health care executives or to manage the affairs of a health care system. The health care business, in short, is too complex for doctors.”

I did not believe what was said then about doctors, and I do not believe it now.  We still have the pride of lions, and we have the intelligence to manage our own affairs.
Tweet:  Consolidation of physicians into integrated health systems is accelerating because of administrative infrastructure required to practice.

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