The art of medicine and strong patient-provider relationships have been ignored in favor of the business and science sides of the profession, argues Medical Group Management Association (MGMA) President and CEO Halee Fischer-Wright, MD, MMM, in her new book “Back to Balance.”
Re-balancing the art, science and business of medicine isn’t about placing blame on electronic health records (EHRs) or government regulation, Wright asserted, while insisting change won’t “come from the top down.”
“But what it will take is a focus on healthier people rather a focus on disease,” Wright wrote in the book’s first chapter. “A system where art, science and business work together to enable to do what is right for each patient, with the time and resources to address more than just the basics; and with providers … who feel supported in their drive to do their best work to help patients be as healthy as possible.”
With the MGMA conference beginning Oct. 8 in Anaheim, California, Wright spoke to HealthExec about the message of the book and what she considers to be the “right questions” the industry should be asking.
HealthExec: The title of the book is “Back to Balance”—so what’s the balance?
Halee Fischer-Wright, MD, MMM: What I advocate in the book is that right now, it’s business and science that are driving medicine to most people’s dissatisfaction. The balance is bringing art back into the equation. I write what I’ve been told is a very compelling argument that art is necessary for us to achieve our business goals.
Why shouldn’t a physician think the balance is all about deregulation—no EHRs, more fee-for-service?
It’s really naïve to think we’re going to turn the clock back to the late 1960s. There’s a reason why regulations have evolved the way they have. What I’m saying in the book is actually pretty clear: The art of medicine is the relationships between providers and patients. The science of medicine is how we treat patients and the business of medicine is how we pay. Those things have to be in balance for people to be satisfied and to get the results we want.
A lot of physicians feel like is if we had less regulation, if I could spend more time with my patients, everything would be better. The reality is that in medicine in 2017 and beyond, you need to have a balance of all three of those things to be a good provider. You can’t just ignore one and go back to the good old Marcus Welby days, where you just had a general practitioner that would hold your hand. That doesn’t exist anymore, but I do think there’s a way that, as providers, we can be much more empowered than we are today.
And what about EHRs?
One of the things I resist in the book is assigning blame. There’s a logical evolution for everything we consider pariah in how we practice medicine today. Do I sense EHRs in and of themselves are to blame? Actually, I don’t, but I think it’s the environment that made EHRs, instead of end user-friendly and acting as a tool to really empower humans, it’s really a business tool. I think that’s where we went sideways on the concept of EHRs.
Several times in the book you talk about healthcare focusing on the “wrong questions.” What are these wrong questions that physicians and practices dwell on and what are, in your opinion, the “right questions?”
Categorically, the wrong question to ask is, “How do we make anything (insert percentage here) better?” That’s just not going to get to any outcome. If you want change, substantive change, if you’re unhappy, you don’t feel like we’re going in the right direction, asking yourself how to make something incrementally better is not going to lead to any effective change.
I think the right questions are pretty much the same for providers as they are for patients. The first question I ask is “How do we treat the person and not just the disease?” As a physician, that’s going to impact the process of how you deliver care, instead of just saying “I need to be productive and see 30 patients per day.” You’re going to have to think about how am I going to get to the financial goals, which is going to cause you to think about alternative business models that’ll help you do things differently.
The second question is “How do we design medical care for healthier people instead of just diagnosis and disease?” The challenge that we have as medical providers is we’re still operating under a paradigm of taking care of sick people when value-based care is engineered to promote health and healthier people. I’ve been practicing medicine almost 20 years. Everything I’ve learned is to identify sick and treat sick. I basically know what healthy looks like, but I haven’t spent a lot of time, effort and energy, people aren’t paying me co-pays to talk necessarily about their health. How do I switch that in my practice?
The last question I think physicians need to ask themselves is how do we ask people the right questions, genuinely listen to their answers and then take the right action? That requires you to have the luxury of time to actually listen and you have to establish trust. That you have the trust with your patients that you’re going to pursue their interests.
How do you get leaders of practices to adopt this approach—do they feel like they can’t when their competitors are still thinking about percentages and seeing more patients, etc.?
It’s almost a human behavior question. In leadership, we talk about change management, but the reality is no one engages in change management if everything is going well. What we have in healthcare, with patients, physicians and system dissatisfied, we’re at a crisis point. Whether we want to or not, we’re at a time of imminent change.
Whereas five to 10 years ago, there was this reticence to really engage on the work of how we can do things differently, because they were basically OK. The thought for many practices is you go first, and if it works for you, I might consider following. What I’m now hearing is a lot more receptivity to trying something, trying anything, because what we’re doing isn’t working.
The rules of standard competition, kind of a zero-sum game, are actually starting to fade. What we’re seeing a lot more of is what I call “collabor-tition,” where we have unlikely partners working together to achieve goal that is greater than what they could achieve by themselves.