There are few professional training trajectories that are quite as unique as that of medical training.
In what other training are you expected to dissect human bodies? In what other training are you expected to simply not need to sleep? In what other training are you responsible for life and death? It's an almost impossibly rigorous path: physically, intellectually, and emotionally. It requires quite complete devotion.
For that reason, the medical path guides medical providers -- especially doctors -- to a very particular skillset and world-view. In myriad ways, that skillset and worldview are admirable, crucial, beautiful, and deeply helpful to society. But that skillset and worldview may also be the root cause of the skyrocketing costs in healthcare -- and here's why...
Dr. Thomas Lee argues in the Harvard Business Review that “the biggest driver of rising costs is medical progress: new drugs, new tests, new devices, and new ways of using them.” He says that this complexity causes workflow and team complications as well as creates a situation in which the providers involved in cases are frequently spread across multiple institutions.
Dr. Lee further asserts that medical providers aren't equipped with the viewpoint or skills to manage the complexity of this situation. He says, “The problem with health care is people like me -- doctors (mostly men) in our fifties and beyond, who learned medicine when it was more art and less finance. We were taught to go to the hospital before dawn, stay until our patients were stable, focus on the needs of each patient before us, and not worry about costs.”
He says that teamwork and collaboration are one of the antidotes to the complexity presented by modern medicine. "Improvements in performance require teamwork... At any organization that provides health care, superior coordination, information sharing, and teamwork across disciplines are required if value and outcomes are to improve."
Despite that acute need for collaboration, Dr. Jamie Stoller, Chair of the Education Institute at the Cleveland Clinic, shares with the New England Journal of Medicine Catalyst blog that the medical training and viewpoint actually make it very hard for medical providers to naturally collaborate.
He says there are 4 factors causing doctors to tend toward being poor collaborators:
- Training favors individual performance.
"Each one of us as a doctor got into medical school on the strength of a strong academic record, succeeded in medical school, again on the strength of a strong academic record, found our way into hopefully fabulous residencies again on the strength of individual performance, [and] re-certifies and certifies with boards in a highly individual performance, so this cultivates deep-seated reflexes for individual performance."
- Training is hierarchical.
That training develops a certain reflex on arrival after finishing training that you’re kind of the king of the hill and can sometimes behave that way.
- Extrapolated authority.
In other words, applying the deep skill and authority in your area of medicine to all other areas of medicine and/or life.
- Physicians are deficit-based thinkers.
The skill involved in learning clinical medicine and differential diagnosis is oriented around finding the problems and connecting those dots -- rather than identifying opportunities and connecting those dots.
Dr. Lee illustrates the very real problems that can arise from poor collaboration in his article. “In my own organization, Partners HealthCare, a poignant example involves the widow of a young man who died of cancer. In the last days of his final six-week stay in the intensive care unit, she demanded that all his doctors have a meeting with the family. The family didn’t really need the meeting, she said—the doctors did. She wanted to be sure that the various physicians were actually talking to one another, because she so often received inconsistent or even contradictory messages from them. The confusion she described does more than distress families, of course. It leads to redundant care and errors that raise costs and threaten quality.”
Doctors aren't prepared well for medical collaboration. And medical costs could be staunched by better medical collaboration. So is there anything that medical providers can do to counter the trend? Well, we certainly think there is.
3 Things That You Can Do to Cut Costs and Improve Your Approach to Medical Collaboration:
- Use tools that streamline workflow.
Just as Dr. Lee explains, much of the increased costs in medicine come from the complex workflows that accompany innovation. That's one reason we think telemedicine that's accomplished through videoconferencing isn't ideal -- yes, it's a tool, but it also exacerbates workflow issues and coordination among providers. Use tools that allow you to consult with other providers on your schedule, with a workflow that works for you, using hardware, you already have.
- Treat medical collaboration with the same seriousness as other parts of medical practice.
Likely because of the medical training that we receive, healthcare collaboration can be seen as a sort of "nice to have" (but not "must have") side activity to the real profession. The more we learn about costs, outcomes, and the more medicine changes, the more this becomes obviously false.
- Identify where your training helps and hurts, and where your personality helps and hurts.
Not all medical training is a negative for medical collaboration. For instance, my attendings were often nurturing leaders who took the time (even if just a few minutes) to work with and listen to me. I always applied this philosophy to my work with medical students. And, in fact, one of the most important aspects of iClickCare is its support of medical education. As the writers above point out, much of our medical training isn't helpful for healthcare collaboration, but some of what we've learned and experienced are things that we can lean into when it comes to medical collaboration -- especially the valuing you likely have for all members of the medical team.
Ultimately, we're optimistic about the potential medical providers have for being great collaborators. But it's important to acknowledge the challenges presented by our time and by the training we usually receive. That way we can build on our strengths while being aware of our weaknesses.
We've rounded up some of the most interesting stories in medical collaboration in our Quick Guide: