Sunday, April 04, 2010

Should Doctors Have Bosses?

As a general rule, we believe that human activity is more productive and more efficient if it is organized and managed.

One prominent exception is patient care. Hospitals are organized and managed. Medical groups are organized and managed. Rehabilitation centers are organized and managed. But the actual care of patients is for the most part left in the hands of individuals.

Like many seniors, I am under the care of multiple physicians – a primary care doctor and specialists for particular conditions. They barely know each other and communicate rarely. When I have used the services of the hospital – either as an inpatient or in its emergency room - I have been cared for by practitioners of various sorts without anyone having overall charge of my case.

That, together with the absence of any accountability for how many and what kinds of services are used by these practitioners along the way, has to be an important reason for the high cost of care.

Why don’t we organize and manage care? The main reason, I think, is that doing so would mean that our doctors would have bosses and we don’t like that. We resist the possibility that the decisions of our doctors might be controlled, or at least significantly influenced, by people who serve as their “bosses.”

And yet, until care is organized and managed it will be inefficient and outcomes will vary.

That is a cultural issue that will have to be dealt with if we are to have true health care reform.

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