Shake It Up Baby, Twist and Shout

Time For Change

So, my friend Dr. Rob Lamberts and I decided to take a couple of hours last night to have a beer, eat some good seafood, and talk about the state of his new practice and healthcare in the United States in general.

Now, I obviously won’t talk about the confidential aspects of his new venture, nor the boring details of what we think about the state of American medicine, insurance reimbursement or traditional medical office structure and function. You may read some of his musings at The Health Care Blog and at Musings of a Distractible Mind. I will, however, tell you that we agreed on at least one thing during our wide-ranging discussion.

It’s going to take a powerful disruptive force to change how healthcare is provided in America. 

@doc_rob is one of the handful of people that I know who is stepping out on a limb, a limb that he is quite sure should not support the weight of his new ideas. He is setting up a new kind of practice that focuses on keeping patients well, not on treating them after they are already very sick. Can you imagine?

I started my training in American medicine in 1979, what seems like a millennium ago now. Like all doctors of my age, I was trained to look at medical illness as a problem to be solved. We learned to ask the right questions, lay on hands to examine, order tests as needed, come up with a differential diagnosis, further refine it as more information came in, make a more definitive diagnosis, and then act by treating the patient. We always saw the patient as sick. After all, if they were not sick, they would not be coming to us. We were taught to be highly skilled healers. In order to perform as a healer, one needs a steady stream of really sick people who need you.

A highly trained physician needs a practice full of really healthy patients like a fish needs a bicycle.

Rob is taking the idea of traditional medical office practice and standing it on its head. He is setting up a scenario where he can teach patients how to be healthy. How to stay well. How NOT to need him.

It’s very hard for me to communicate to you how extremely radical this notion is. It scares the hell out of the establishment, who, at least for now, hold all the cards. The powers that be hold the keys to the hallowed halls, the big diagnostic machines, the pharmacies full of expensive pills, and most of all, the power to decide what is and is not reimbursable and even worthy of payment.

If radicals like Dr. Rob are successful, and I have to tell you I think they eventually will be, American medicine will never be the same.

For a psychiatrist who sees patients who have both emotional and physical illnesses, this is an intriguing model. What if we were able to take the time to proactively look at families who are at risk for depression, bipolar disorder, schizophrenia AND the medical illnesses such as diabetes mellitus, coronary heart disease and hypertension that go with them? What if we could involve a dietician, a social worker, a diabetes educator, and other professionals at the front end for preventative care, instead of waiting for the first episode of diabetic ketoacidosis or the first time someone is homeless to intervene. How wonderfully radical would that be?

It would mean focusing on the needs of the patient, and it would mean trying to keep the patient well, not the medical establishment.

I will go to work today, as I do most every day. I have thirteen patients on my schedule today, a lot for a psychiatrist in a busy mental health center clinic. All of them will come in and tell me how very sick they are, how much they need the pills that they take and how they need to see me and their counselor more and more and more to be able to function at even a minimal level in the world. This is exactly what they have been trained to do. This is exactly what I have been trained to do.

Wouldn’t it be nice to live in a medical world where my success, and the success and health of my patients, was measured by how well they were and how little they needed me?

Radicalism.

Heresy.

Disruption.

It’s beautiful thing.