Sunday, August 16, 2015

Why Medicine Isn't Like Amazon.com

The New York Times expose (hit piece?) about Amazon.com was definitely eye opening. After reading it, I am both impressed and disgusted at how the online shopping site runs its business. The article even includes a link to Amazon founder Jeff Bezos's guiding principles on why his company has become such an unstoppable success. Presumably anybody who follows his guidelines can surely reap the same accomplishments as him.

However, when I looked through the list, I realized how polar opposite the business of medicine is from Amazon. Maybe this is why the country's healthcare system spends more money than anybody else in the world yet receives poorer marks from its citizens on health and satisfaction. Here are Mr. Bezos's doctrines and why medicine doesn't fit the mold.

1. Customer Obsession--Medical professionals are obsessed that so much medical care is granted for free to our indigent patients/customers. Some figures put the amount at $85 billion annually. Obamacare aims to reduce the number of uninsured. But with Medicaid level reimbursements, the compensation is just enough to keep the system starving itself into oblivion over a longer period of time.

2. Ownership--Doctors don't own the patients. Insurance companies and the government own them. We are just here to do the work.

3. Invent and Simplify--Medicine's rule is to make things more complicated than necessary. Ask doctors how they like their electronic medical record system and you'll get a spiel on the frustrations of the needless complications it has added to their daily lives.

4. Are Right, A Lot--We maybe right a lot, but nobody's listening. Patients google their symptoms and come into the medical office telling their doctors what to do for them. Faceless insurance adjusters second guess physicians daily on the right treatment for patients. Malpractice lawyers? Their whole raison d'etre is accusing doctors how stupid they are.

5. Hire and Develop The Best--You know where the best and brightest youths in this country are heading? Amazon, Google, Facebook, Apple, Goldman Sachs, JP Morgan. Kids aspire to entire fields where they can make a lot of money and/or develop potentially revolutionary products. Medicine is neither. Doctors who become very wealthy don't practice medicine. They're in business administration or life science research.

6. Insist on the Highest Standards--Doctors and patients may insist on the highest standards of care, but the insurance companies won't pay for it. But if doctors don't do it, they will sue the pants off of you. So it's just more uncompensated care that physicians and hospitals have to swallow.

7. Think Big--Medicine wants to think big, but then the Department of Justice brings down an antitrust ruling to keep the businesses as inefficient and fragmented as possible. Good for the payers. Not so much for the medical field.

8. Bias For Action--You try to get patients out the door but then they accuse you of dumping them. Then they penalize you when the patient is readmitted within 30 days. So why hurry?

9. Frugality--$1,000 per pill? Nobody wants frugal medicine. They want free medicine.

10. Learn and Be Curious--That is the mantra being advanced by the American Board of Medical Specialties. But then they force their cumbersome and expensive Maintenance of Certification program on all doctors leading to a nationwide revolt. Doctors don't want to learn and be curious after they have their precious little certification clutched in their hands.

11. Earn Trust--Patients don't trust doctors any more than doctors believe patients are telling them the whole truth. Why do you think there are so many conspiracy theories about children's vaccines and how they are a scheme concocted between the pharmaceutical industry, doctors, and the government.

12. Dive Deep--Clock in, clock out. Eventually we're all going to become employees of the system anyway so why bother.

13. Have Backbone; Disagree and Commit--Pretty soon you'll get a call from the hospital's Patient Advocate office asking why a patient's family is filing complaints about your disagreeable character. Then you'll have to take time off from work to face a hospital committee explaining why that family is a bunch of wackos who is making life miserable for anybody who has to be involved in their relative's care.

14. Deliver Results--Patient survived the operation. I'm out the door to my S Class in the parking lot on the way the gym where I get my real satisfaction in life.

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