Another year passed by, and I was going to write about my wishes for the New Year as a hospital doctor. But then, remembered that I did something very similar a couple of years ago. I went back and read over my wishes and found that they are identical to my wishes now! That’s not to say we haven’t made some great progress but — as anyone in health care knows — moving the needle is a herculean task.
1. Health care information technology. Hopefully, hospitals will start working towards optimizing health care IT with front-line clinical workflow. What we have right now (and I speak as someone who has worked in several different hospitals) is for the most part slow, inefficient and cumbersome to use. It takes time away from patients and causes great frustration for both doctors and nurses, who are spending less and less time with their patients. For the sake of good medicine and also pleasing our patients, we need to design better IT systems, move away from “click-box medicine” and ensure that health care IT does more than just satisfy administrative requirements. Even the most hardened technophobe will agree that information technology is the way of the future, so let’s make it better.
2. Patient safety and health care quality. Great strides have been made in this area, but we need to make sure that the efforts are both effective and meaningful. Many of the same unsolved problems still exist as last year (and, indeed, 10 years ago) such as improving medication reconciliation and the discharge process.
3. Patient satisfaction and improving the hospital experience. Ask any patient what they really want from their hospital stay, and the answers are usually extremely simple. Things like increased face time and better communication with their doctors and nurses, clarity on wait times and the ability to get a good rest while in the hospital. Hospital administrations across the country need to focus on the real fundamentals of good hospital care and move away from “patient satisfaction” being a bumper sticker. Get these things right, and huge rewards are to be had.
4. Direction of health care consolidation and private doctors. I first came to the United States to start my residency in 2005 at a time when the current crop of changes to health care was just beginning. I did my residency training in Baltimore, and have since worked up and down the East Coast. Having come from a very different system (the United Kingdom), one of the first positive things that struck me about the U.S. system was the dynamism of U.S. physicians who were in private practice and the choice and flexibility this gave to patients. Over the last decade, there has been a relentless push towards consolidation and employed doctors. Solo and small practices are finding it increasingly difficult to thrive. I sincerely hope that the pendulum begins to swing back the other way because I feel this will be better for both patients and physicians. The question is: can we do this with the added need to also control costs? I hope so.
5. Health care costs. I don’t believe that the need to control costs necessarily means that there has to be a stark choice between the traditional U.S. model of health care or moving towards a more centralized system that exists in European countries — with all of the restrictions, control and rationing that goes with that. There are several hybrid models that exist in countries like Australia (where I’ve worked, too, and seen excellent care delivered). My hope is that we can reconcile the need to control costs without adopting a more controlled system where physicians and patients feel their choices and freedom are limited.
There we go — my New Year’s wish list. The best people to make health care choices will always be the patient and their doctor, and this relationship always needs to remain front and center of any care system. Whatever the New Year has in store, physicians need to work together to ensure we move in the right direction and make health care better.
Suneel Dhand is an internal medicine physician and author of three books, including Thomas Jefferson: Lessons from a Secret Buddha. He is the founder and director, HealthITImprove, and blogs at his self-titled site, Suneel Dhand.
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