Why Doctors should flip-flop

Doctors have an interesting problem. They have an ingrained professional obsessive – compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait … it results in high quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the healthcare system, they falter. Stuck in silos, they fail to adjust their focus. They resist systemic innovation. Because they cannot flip, they flop.

This habit, resisting change, staying focused on the trees, instead of the forest, means that significant system evolution often occurs without physician voices, simply because doctors refuse to be involved. This results in error, inefficiency and lost opportunity. Paradoxically, when flawed change is forced on the medical system, it burns out doctors. Thus, instead of working as a team, involving themselves from the start in building and growing, physicians become victims of change, reduced to painful irrelevance. Therefore, the failure to build functional healthcare and the miserable state of many health systems is, to great extent, because of the self-imposed isolation of physicians.

A couple common examples will suffice. Doctors have fought, tooth and nail, against the precertification process of health insurers. They battle against the payers with the indignant anger of neglected children. However, insurers have been forced into an intrusive system of obstructive payment, because doctors refuse to mind their own shop. Physicians insist on ordering what they want, regardless of cost or net patient benefit. Doctors do not watch the henhouse, so someone else has to. It would have been a very different world if, from the start, the medical profession had accepted financial stewardship as part of their mission.

Look at information technology. Healthcare is the last major industry to transition to a silicon base for decisions and communication. Because doctors have blocked IT every step of the way, non-medical personnel, who often fail to appreciate the needs of doctor and patient, have written EMR’s. And, because doctors have not seized on the power of the EMR as a patient care tool, the billers and insurers took control, so that the average EMR is not only clinically inadequate, it is focused on coding, posting and accounts receivable.

If healthcare is to produce the best quality and personal result for every patient, doctors must leave their self-imposed isolation. They must make, what can be a very difficult transition, that of changing of thought from the bedside to the boardroom and then back again, often in the same day. This requires a different kind of focus. One moment a doctor is teacher. The next marketer. The next scientist. The next isolated responsible decision maker. The next collaborative team player. The next emotional supporter. The next metric driven organizer. One moment just you and the patient, and the next a round table of analysts, administrators, lawyers, financiers, community leaders and accountants.

Doctors fail to lead in health, because they have not become comfortable in each of these roles, and particularly have not learned how to change from one to another, in a moment or an afternoon. Added to this is the emotional drain of being a physician. It is remarkably hard to sit at a bedside with a dying patient and family, watch the monitor go flat, hold a wife in tears and then walk down the hall, around the corner, and sit down at a meeting to discuss ordering supplies, retooling an information system or hiring a new director. It yanks the mind and soul. It requires patience, experience and skill.

Nonetheless, this is exactly what medical schools must teach, and doctors should strive to develop. The physician who can bring, in real time, the experience of the patient to the leadership process, tempered with an understanding of how complex biology and business systems interact, adds an incredible amount of value to healthcare. This is critical to the development of medical systems that actually work to the maximal betterment of every patient. Such leaders will be invaluable to the future of healthcare.

This is more difficult than common multi-tasking, carrying out two or more similar tasks, simultaneously. For most physicians this is routine. This is the harder skill of changing one’s acute focus between entirely different cultural and intellectual functions. However, this is a vital skill for doctors to obtain, because no matter what a physician does, in the OR or auditorium, in the exam room or corporate office, with a nurse or CFO, she always carries the love and understanding of the patient.



  • Dr. L Schouten
    As has been stated by others: "If you are not at the table, you are on the menu." When will we ever learn...
  • harimohan55Dr Harimohan
    i agree completely
  • D Someya Reed
    I was with you right up until the end. More about that in a moment. What you've written about is not unique to physicians. Certainly the stakes are much higher for them but almost all positions within organizations (if not just plain all) now require one to assume many roles at any time. Think of even a "lowly" retail clerk...I can speak to this without prejudice or disrespect as I've been one at multiple times in my working career and it is "lowly" in the eyes of far too many. Yet, this same retail clerk who may only want to nicely fold the T-shirts in her section as she was hired to do is now expected to act as customer welcome committee, customer dispute mediation, customer fashion consultant and personal shopper, time scheduler and employee dispute mediator (if the boss is away), cost efficiency expert/auditor/financial consultant in team meetings, loss prevention associate for unexplained shrinkage, cashier and cash handler, material handler and truck freight unloader (formerly the now PC stock-person), human resources (when asked to interview and evaluate potential new hires in the now common "group" interview setting to assess organizational fit), trainer for those who are hired, presenter and guide to visiting executives (if the boss is out of town or doesn't want to do it..."you're so much better at this") and many more including the role of team leader. Even when on her own time, she must remember that she represents "the face of the organization" in all she says and does. On a basic level, sounds pretty similar to what you describe for physicians. Still, retail clerks are not trained to wear these hats yet are expected to do so and do them all well or face termination. Gone are the days when any employee of most any organization was expected to stay silent (shut up), do his job and go home. Giving voice to an opinion/suggestion or having a say was neither expected nor desired on much of anything. At that time, when they couldn't, employees wanted more, wanted to have that say. Now that they are "expected and/or required" to be more involved and more vocal, they don't want it. Again, seems to be the same for physicians keeping in mind that higher stakes (life & death) may be involved. So why have "we" allowed physicians to build and hole up in their silos? If we're not training them to wear multiple hats now, why have we waited so long or what are we waiting for? Why are we giving them a pass on termination for "flopping" if they don't wear their hats well? So back to where I stopped being "with you." It's your very last sentence. Actually, the last ten words..."she always carries the love and understanding of the patient." Is this the "love and understanding" of the patient bestowed upon the physician or that of the physician bestowed upon the patient. Unfortunately, neither are "always" or universally true. Certainly it sounds good to say so in a written piece such as this but if this were always true why would it be as difficult as it is to find a physician that even puts up a decent pretense of caring for the patient, let alone escalating it to "love and understanding?" Again, I speak from years of personal experience and years of stories from others some of whom relayed theirs on this very blog. Some will say that these experiences we've had are all "anecdotal," perhaps even "rare." So, how many "anecdotes" does it take to become statistically significant? That's not a joke.
  • A great part of the problem is that doctors are so busy doing what they have been trained to do, and they have continually increasing responsibilities (patients, "e-paperwork," etc,). So they feel both guilty and foolish abandoning specific responsibilities for the vague, administrative, "leadership" tasks that can become very frustrating very quickly.

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