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Dear health care administrator: Physicians are your friends

Dear health care administrator,

I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage on the side while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the science and “guidelines” of medicine to individual patients with multiple interwoven problems with disease presentations that seldom match their textbook descriptions. We need each other, at least under the current system. So I ask you to view us as allies, because we actually do the work that ultimately pays your wage or your profit, and is the basis for your own performance metrics. We are in this together, like it or not, so let me ask that you don’t do some of the things that several of your colleagues are doing:

Don’t squeeze us too hard.

When you do, the quality of our work, the health of those we serve, is in jeopardy. Instead of just imposing productivity targets, quality thresholds or pay-for-performance schemes, listen to what we need in order to keep our patients healthy. Invite us to the table; we actually know a lot about how to work smarter, faster and better, so don’t be afraid of our participation. If we feel squeezed and abused, you will get perfunctory performance, but if you partner with us, we can, together, make patient care much better.

Don’t tie our hands.

I know you mean well, but when you pick or design tools and workflows for us to use, you often make it harder for us to do the work that patients need us to do well.

Don’t give us EMRs that cut our productivity in half, when computers have streamlined work in other sectors; don’t make assumptions about how doctors think and how we process information. For example, let me read CT scan reports and other test results, without scrolling, right when I see my patient in follow-up, import them into today’s office note, and “sign off” on them right then and there, not after my office hours when I should be spending time with my family. And, also, when I am in today’s patient note, let me see all recent results, consultations, calls and refills without clicking on several “tabs” that may not have any results under them. Data is meaningless without context, and a good computer system should enhance the context behind the data.

Don’t slap our hands.

Doctors are highly motivated individuals, who generally work harder than anyone asks them to. If we don’t seem to do what you want us to do, it is either because we think you are asking us to do the wrong thing or because you haven’t given us the tools to do the right thing. We don’t need to be prodded along like cattle, and we don’t respond to being slapped.

Don’t bite.

Don’t inflict pain and don’t threaten us with it. Our first inclination will likely be to take care of our patients and ignore you, but we will ultimately respond if threatened or attacked enough. You may think of health care entrepreneurs from the business community as introducers of disruptive change, but consider the possibility that physicians, if pushed too far, could be the ultimate disruptive force in health care.

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes

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