When I was a young woman in high school, I bought the book, The Social Transformation of American Medicine written b Paul Starr, which in my mind is still a historical classic today. I made this purchase because I was going to be a pediatric surgeon (we all know how that turned out…) and wanted to learn about the industry I was going to dedicate my life to. You see, I wanted to go into medicine to help people, to serve people and to be part of a community.
Fast-forward a couple of decades (give or take…) and I am not a pediatric surgeon but I do have a doctorate in Health Services Research and maybe even more importantly, I am on a mission to reach and serve one million women in the next 5 years. Why this mission? Because I dedicate my life to help people, to serve people and to be part of a community.
What is sad to me is that I do have friends who are amazing physicians and surgeons and nurses and nurse practitioners – and do you know what one of their biggest complaints is? You guessed it…they don’t feel as if they are really helping people, really serving people nor a strong part of their community.
While I am still a recovering health services researcher (okay, I admit that I still love science and research and incorporate these studies into all of my work), I do read the Health Services Research Journal. Not religiously, but I do still read it when it comes in the mail. The latest special edition of HSR is titled: Incentives for Physicians; What we know and what we still need to learn. Now, I know many people who are editors of this journal as well as contributors and I have so much respect for them and for their work. But I do question the need for even more studies on physician behavior when it comes to our health care system. And here’s why: Because we already know that:
- Financial incentives can be used to improve medical care
- Helping physicians’ reputations can be used to improve medical care
- Sharing physicians’ previous results with patients via public reporting can make some difference but that a lot of information is shared via word of mouth
- We need to ensure that physicians feel good about what they are doing and pay them well for providing great care.
But what I don’t see in many of these studies is the human being – the actual physician – side of things. Some physicians want to make money, some want to serve and some want both. Knowing this can be invaluable in developing payment mechanisms. Yet, this angle is not discussed much or as Jack Nicholson would say “Things you don’t talk about at cocktail parties.” [A Few Good Men is one of my favorite movies so I like to slide in those references when I can].
At the end of the day, the United States could be described as a sick country. Almost one-third of folks have (or could be diagnosed with) Type II Diabetes, we don’t move much, we eat more than we should and spend a lot of time either watching TV or talking about people who are on TV. It’s hard for a physician to provide high quality care to many people who don’t treat their bodies as something of high quality the first place.
We do need to have financial systems in place to pay doctors and all clinicians for their great and hard work. Yet, we also need systems in place to hold individuals, patients, people accountable for themselves as well. It is a 2-way street and we need to start more real conversations around this idea if we really, truly want to achieve the Social Transformation of American Medicine.