Author: Shawn Whatley

Healthcare Accountability vs. Healthcare Incentives

Power Struggle Between a Man and a WomanWar erupts when:

Bureaucrats demand accountability without expecting to pay for it.

Physicians expect incentives without any accountability for outcomes.

We need both. 

Accountability without payment = slavery.

Incentives without accountability = robbery.

No accountability or incentive = retirement (or tenure, or union seniority, or sinecure)

We need rigorous accountability AND meaningful incentives.  We need system leaders to be comfortable with both.  We need experts able to align incentives and reward outcomes that benefit patients.

But, accountability presupposes freedom. 

Accountability must be demanded inversely to the amount of rules given:

If payers micro-manage every system process and detail, they remove freedom from providers and have no right to demand accountability. 

Give providers freedom, then demand accountability.  It makes no sense to demand accountability without giving providers freedom to deliver results.

What do you think?  Do we need more accountability?  More incentives?  More freedom?

Avoiding Patients – How Docs Defend It

Paternalism

I convinced myself I was dying of prostate cancer last year.  Turns out, I was drinking too much coffee.

Patients often seek help for things that turn out to be pretty simple.

They laugh afterwards.

Phew!

Thank God it wasn’t cancer.

Many physicians sincerely believe that their staff can safely dismiss a patient’s concern over the phone, or put off seeing a patient for days (or weeks!).

By the time someone has ramped up the courage to seek help, his anxiety has peeked; he can’t take it any longer.

Patients finally give in and get seen; like Lightning McQueen finally going to buy some tires in Cars:

Lightning McQueen:  All right, Luigi, give me the best set of black walls you’ve got.

Luigi:  No, no, no!  You don’t know what you want!  Luigi know what you want!

Avoiding Patients

When patients want to be seen in the office that day, physicians argue that:

  • They know it’s not a serious problem.
  • They know it can wait.
  • They know the patient will be fine.
  • They know best.

Patients often think they need medical help when there’s nothing medically serious going on.

But, unless physicians get radically committed to understanding and meeting the perceived needs of patients, medicine will lose the privilege of caring for patients’ concerns or be tolerated begrudgingly until some better option comes along.

How soon would you like to see your family doctor if you called for something that really worried you?  Do you like getting a “We know best” attitude?  Do you like having to worry while you wait for an appointment?