I’ve been writing a blog post on this topic for a few months.
It’s gone through several iterations and has survived a half-dozen friendly editors. This post isn’t that post, which still needs honing and will follow in the coming days. This post is the personal prelude – the why that perhaps is important to share before the what.
Simon Sinek says we should start with why.
My decision to go to medical school was long-delayed. Indeed – I took no science classes in college – assuring myself that I would not follow the path of my father and grandfathers – all of whom were physicians. Yet the magnetism of this profession was compelling, once I let it pull me. I vividly recall wanting to do work that was useful and helpful. Auto mechanics seemed appropriate. I rebuilt my VW’s engine (twice) and helped others fix their cars.
But something was missing.
The human part.
And yet – when I finished residency and joined the faculty in the Department of Family and Community Medicine at Albany Medical College, I knew that something was still missing. My idealistic view of our profession was conflicting with the real-world experience: payment was an overlay on nearly everything we did – influencing what we document, how we document, and what decisions we made for (with?) the people we serve. One example: the annual physical. It’s a tradition that still hasn’t died – yet it offers almost zero value, yet the annual physical occupies as much as 20% of the work that’s done in primary care today.
In addition to doing things that are unnecessary – we still don’t do necessary things with sufficient frequency. Consider that about 65% of people in the United States who should have colon cancer screening actually get it. Organizations that accomplish rates of 75% are deemed wildly successful. How has 75% success (a “C” in most educational institutions) become synonymous with great achievement? This makes no sense to me.
Finally – service. While this 2010 video may be starting to show its age, much of the egocentrism of care delivery organizations persists. We medicalize normal variants of human experience, we ignore (or fail to act on) social determinants of health, and we schedule interactions where/when/how it best meets the needs of the providers (most often physicians) rather than the people who are being served. This 2019 Advisory Board survey found that net promoter score for primary care in the United States is -1.2 and notes that “… more respondents said they probably or definitely would not stay with their provider over the next 12 months (45%) than said they definitely would (40%).”
We must do better.
I’ve written previously about why words matter. Some have asked me why I don’t care about care. Oh my. I do! We need a great care delivery system that’s efficient and effective and compassionate. But “care” is not why our professions exist. It’s not (and should never be) our why. Rather – our why is health. If there are better ways to facilitate health than care (there are) we should embrace those alternate paths – rather than propagate the idea that more care = more health.
And recall that the WHO defines health as “complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
So our goal is (and should always be) to put ourselves out of business and facilitate the achievement of health in the people we serve.
This is why – in two posts to follow – I’ll explain why my next career engagement will be the pinnacle of my life’s work – to realize the idealism with which this all started. The world is finally ready for what comes next: the turn of our wheel to change the words and – by extension – everything we do. I will no longer be a primary care physician. My future – and ideally the future of many others – is to practice primary health.
Because everyone deserves this. You too.