Shake It Up Baby, Twist and Shout

Time For Change

So, my friend Dr. Rob Lamberts and I decided to take a couple of hours last night to have a beer, eat some good seafood, and talk about the state of his new practice and healthcare in the United States in general.

Now, I obviously won’t talk about the confidential aspects of his new venture, nor the boring details of what we think about the state of American medicine, insurance reimbursement or traditional medical office structure and function. You may read some of his musings at The Health Care Blog and at Musings of a Distractible Mind. I will, however, tell you that we agreed on at least one thing during our wide-ranging discussion.

It’s going to take a powerful disruptive force to change how healthcare is provided in America. 

@doc_rob is one of the handful of people that I know who is stepping out on a limb, a limb that he is quite sure should not support the weight of his new ideas. He is setting up a new kind of practice that focuses on keeping patients well, not on treating them after they are already very sick. Can you imagine?

I started my training in American medicine in 1979, what seems like a millennium ago now. Like all doctors of my age, I was trained to look at medical illness as a problem to be solved. We learned to ask the right questions, lay on hands to examine, order tests as needed, come up with a differential diagnosis, further refine it as more information came in, make a more definitive diagnosis, and then act by treating the patient. We always saw the patient as sick. After all, if they were not sick, they would not be coming to us. We were taught to be highly skilled healers. In order to perform as a healer, one needs a steady stream of really sick people who need you.

A highly trained physician needs a practice full of really healthy patients like a fish needs a bicycle.

Rob is taking the idea of traditional medical office practice and standing it on its head. He is setting up a scenario where he can teach patients how to be healthy. How to stay well. How NOT to need him.

It’s very hard for me to communicate to you how extremely radical this notion is. It scares the hell out of the establishment, who, at least for now, hold all the cards. The powers that be hold the keys to the hallowed halls, the big diagnostic machines, the pharmacies full of expensive pills, and most of all, the power to decide what is and is not reimbursable and even worthy of payment.

If radicals like Dr. Rob are successful, and I have to tell you I think they eventually will be, American medicine will never be the same.

For a psychiatrist who sees patients who have both emotional and physical illnesses, this is an intriguing model. What if we were able to take the time to proactively look at families who are at risk for depression, bipolar disorder, schizophrenia AND the medical illnesses such as diabetes mellitus, coronary heart disease and hypertension that go with them? What if we could involve a dietician, a social worker, a diabetes educator, and other professionals at the front end for preventative care, instead of waiting for the first episode of diabetic ketoacidosis or the first time someone is homeless to intervene. How wonderfully radical would that be?

It would mean focusing on the needs of the patient, and it would mean trying to keep the patient well, not the medical establishment.

I will go to work today, as I do most every day. I have thirteen patients on my schedule today, a lot for a psychiatrist in a busy mental health center clinic. All of them will come in and tell me how very sick they are, how much they need the pills that they take and how they need to see me and their counselor more and more and more to be able to function at even a minimal level in the world. This is exactly what they have been trained to do. This is exactly what I have been trained to do.

Wouldn’t it be nice to live in a medical world where my success, and the success and health of my patients, was measured by how well they were and how little they needed me?

Radicalism.

Heresy.

Disruption.

It’s beautiful thing.

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7 thoughts on “Shake It Up Baby, Twist and Shout

  1. Greg, this is where the medical model and the nursing model can inform one another. I was trained in nursing in the seventies and this is exactly the model nurses have been using for years: to see the patient as a whole person and practice in such a way as to maximize wellness and prevent illness. But the medical establishment (with a fix-the-problem orientation) has held the power and controlled the resources for all the reasons you state. It would be wonderful if we could find a way to integrate the best of both models and improve quality of care and quality of life while reining in the ridiculous cost of health care in this country. I applaud your friend for thinking radically about this. Thanks for this post.

  2. FANTASTIC!
    As an English instructor at Model High School, I was often considered radical in that I actually “planned” to help each of my students aim to make a A in any class that I taught.
    What? Are you crazy?
    If you don’t have a BELL CURVE in your grades, YOU are NOT a good teacher.
    Guess I was a total failure by those standards, but I don’t feel like a failure.
    Each high school student should have someone who believes in him/her and works to help that young person be proud of his/her efforts. I believed it them; I still believe it today.
    RADICAL…SO WHAT!
    Sometimes–actually more often than not–the positive approach worked for me and, I believe, for many of my “kids.” My, oh, my! Those were the good old days!

  3. Love the idea! Being radical is sometimes a very good thing. Change for the better must come in some form. This novel idea sounds like the ticket to me! I hope your friend is successful in his practice!

    M

  4. Susan,

    Absolutely agree!

    My compatriots in the country of medicine are a stubborn lot.

    We will hold onto our old ways of training, thinking and working until they are wrested from us, I’m afraid.

    Greg

  5. Ms. B

    Isn’t it funny how we all get lock into what is considered acceptable and standard, to the detriment of those we are trying to target and help? I find that with patients today; you found it with us as students years ago.

    Those who innovate and push for change are often derided as radical and heretics. Funny, but they are the ones who change things and move us all forward.

    I’m looking forward to visiting the grounds where one of those folks lived. I’ll be at Monticello on Saturday, trying to gain inspiration from Mr. Jefferson.

    Greg

  6. I love your disruptive health theory. I think we’re close with big data. As we work more toqards the quantified self with metrics, loggers, and trackers we usher in a new era of perfective health and personalized medicine. For example, you’re wearing a wristband, you have an implanted microchip, of even your digital underwear (crazy, right?) could alert you to an otherwise undetectable biorhythm that is predictive of future disease. Then you work with your HCP to design a healthy protective treatment plan…oh and there would need to be reimbursement for this. I dream that we’re close but then I look at the $$$ aspect and I feel like we’re so far…

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