Old news – we are all living in a healthcare world where acute and infectious disease (and their related costs and the associated system capacity) have given way to a world where non-communicable diseases and chronic diseases often related to lifestyle behaviors and risks dominate our healthcare costs. And unfortunately there’s limited resources available for redesigning the system from top to bottom to address the infrastructure needed for this world that has emerged, and the systemic requirements for patients to succeed in this new world are simply absent in our current reality.
Consider this… in the world we used to live in, after the 10 minute doctor visit, a physician could ‘care’ for his or her patient by doing a procedure (or prescribing one) or writing a prescription for some pharmaceutical. Efficient – specialists at all levels available to offer prescribed procedures, or a pharmacy on every corner ready to provide the requested drug – easy peasy as they say. We have built a humongous infrastructure to deliver these things. Vendors, suppliers, buildings, a shared and acknowledged evidence based understanding about what works, and how to efficiently spend ‘our’ money to get a cure. But that was the world we used to live in.
As for the world we now live in, after that doctor spends 10 minutes with a patient, now they counsel the patient to ‘live less stressed, eat better and lose some weight’. And all over America, physicians are in a quandary. First off, they are often stressed themselves, frequently (though less so than their patients) overweight and eating worse than they should. So in this new world we have doctors wanting to ‘prescribe’ behavior change, weight reduction, and a better diet. Unfortunately for them and for their patients, this new world is about behavior, NOT about prescription. And behavior is hard, and none of the existing infrastructure was designed to change behavior. Not how doctors offices are designed, or how communications systems work, how medical records are built, or how insurance is conceived and administered.
The start to the solution is for all of us to recognize what is missing. Its not another diet, or a better nutritionist. Its infrastructure, vendors and compensation for behavior change. Its developing vendors who can really address change in real life, not in a research study. Its about tools that will work across a range of practices and physician styles. Different offices have different resources- we have to design an infrastructure that works for sole practitioners, as well as large group practices. For hospitals and for specialists. And we can’t expect each entity to figure it out on their own. That’s just not practical or economically sound.
We must discover a way to empower the existing infrastructure, and allow doctors to actively participate in their patients’ health improvement journey. While empowering the patient is vital in this process, what is really important is to rethink our infrastructure. Redeploy our resources to address the world we are living in today, while fully appreciating where we have come from.