Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Health care is on a different trajectory from most other businesses. Why is that?

Hans Duvefelt, MD
Policy
November 29, 2018
Share
Tweet
Share

Health care is on a different trajectory from most other businesses today. It’s a little hard to understand why.

In business, mass market products and services have always competed on price or perceived quality. Think Walmart or Mercedes-Benz, even the Model T Ford. But the real money and the real excitement in business is moving away from price and measurable cookie-cutter quality to the intangibles of authority, influence, and trust. This, in a way, is a move back in time to preindustrial values.

In primary care, unbeknownst to many pundits and administrators and unthinkable for most of the health tech industry, price and quality are not really even realistic considerations. In fact, they are largely unknown and unknowable.

The real price in primary care isn’t just the cost of each doctor visit. It is the cost of the total number of visits needed to solve a problem, and also the cost of the various tests, procedures, and treatments each primary care doctor orders when solving that problem or managing a particular condition. This can vary enormously.

In accountable care organizations, actual costs are compared to presumed or projected costs, which are based on hierarchical condition categories (HCCs), which aren’t well known or commonly used by primary care doctors. To a degree, you can game this baseline cost calculation by mastering HCCs (Medicare Advantage plans’ financial well-being hinges on making the most of this; this is why they offer doctors $150 to sign off on a list of each patient’s known or suspected expensive diagnoses).

Quality in health care is largely in the eye of the beholder. I’ve said it before, and I’ll say it again here: A patient population’s immunization rates or aspirin use or non-use (depending on shifts in knowledge) are not comprehensive measures of quality. Accuracy of diagnosis, if anything, is. But who is measuring that? You might say “those who can’t practice medicine measure it.” That’s why most quality measures these days are of things you don’t need a medical degree or license to accomplish.

Primary care, in the eyes of our patients, is instead about relationship, authority, trust, and (gasp) convenience. This is what people in most other businesses talk about all the time. It is what even tech and medicine pundits, EMR companies and many other middlemen want for themselves. They don’t want to be evaluated on the basis of price or quality standards set by others. Yet they want mass market medicine for the masses, not relationship-based care.

Driving 200 miles between my two clinics, I often listen to audiobooks. Once I finished my board review, I turned to business books. “Influence,” “Authority,” “Brand,” “Story,” and “Content” have replaced “Quality,” “Six Sigma,” and “Excellence.” In business now, it is all about standing out and setting your own standards. It is about building relationships with and listening to consumers.

In health care, I see the paradox that insurers are now reaching out to patients to check up on them while at the same time making doctors work so hard and so fast producing “encounters” that there is less and less time for us to talk with our patients when we are with them, and never mind on the phone in between visits. Do they really think patients wouldn’t rather see their own doctors having enough breathing room to talk to them than have some strangers from out of state they never met calling to check in?

We have data that the doctor-patient relationship influences outcomes. From hospitalization rates to prescription adherence to effectiveness of treatments for mental health diagnoses, it is well known that the doctor is a large part of the treatment.

Doctors have increasingly become part of multicenter systems that, in spite of efforts like patient-centered medical home recognition, simply have become too large and impersonal to foster the kind of customer relationships the business world is now realizing are necessary.

Between the bottom-line objectives of such health care organizations and the bureaucracies of health insurers, doctors and patients are clearly not in complete charge of their own relationships anymore.

So what happens with those relationship dependent outcomes when so many doctors feel like lineworkers, rather than professionals? What happens to their ability to nurture those relationships, gain that authority and earn that trust?

ADVERTISEMENT

What happens if they lose it altogether?

There are modern, big companies who listen to their customers, even research and anticipate their customers’ needs. There are companies that empower their employees to solve customer problems, give refunds and do extras. There are companies who treat employees like owners or even offer them actual ownership.

Health care could do some more of that.

But there is more, lest we forget: Doctors aren’t just employees.

Who has the license to practice medicine? Who places the needle or scalpel? Who selects the medication? Who says “I’m sorry, we did everything we could” or “Congratulations, it’s a beautiful baby girl”?

Salespeople, YouTube stars and business leaders give a lot of thought to their customer relationships, their personal authority and the essentials of building and maintaining trust.

Are we doctors doing enough of that? Those things are ours to claim, and to strive for. Even if a big corporation issues our paycheck.

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

Image credit: Shutterstock.com

Prev

Employee recognition: How to show your appreciation this holiday season

November 29, 2018 Kevin 0
…
Next

Fear of missing out can be self-defeating

November 30, 2018 Kevin 0
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Employee recognition: How to show your appreciation this holiday season
Next Post >
Fear of missing out can be self-defeating

ADVERTISEMENT

More by Hans Duvefelt, MD

  • The art of asking where it hurts

    Hans Duvefelt, MD
  • Thinking like a plumber when adjusting medications

    Hans Duvefelt, MD
  • The American food conspiracy

    Hans Duvefelt, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • Health care workers should not be targets

    Lori E. Johnson

More in Policy

  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Health care is on a different trajectory from most other businesses. Why is that?
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...