There’s a breakdown in the consumer healthcare system experience today that should be driving us to ask, ‘Where’s the conductor?’
Since the patient experience is recognized as an independent dimension of healthcare quality, we need to ask who the quarterback is in today’s healthcare system. Who is the patient advocate that truly knows or understands a person in their entirety? Who puts together the puzzle pieces of results and assessments from disparate specialists?
Recently, I have been caring for a parent. We have an established primary care relationship which we have valued and respected for years. Unfortunately, the last two years of health issues have exhausted the knowledge base of primary care. Primary care physicians have stated that their scope to confidently treat has narrowed and they now rely on specialists and the emergency department. In addition, if an individual presents with symptoms that could align with multiple illnesses the patient is now sent to the emergency department for testing, diagnosis, a care plan, and instructions to follow up with primary care. Primary care physicians claim they are no longer afforded the time to focus on coordinating tests from different departments, analyzing results from across systems, and developing and managing a treatment plan which their knowledge may or may not support. Being knowledgable about healthcare paid off. We were able to avoid an inappropriate emergency department visit and obtained and an antibiotic by evenings end.
Another example: A woman with a sinus/respiratory infection rushed herself to the ER because the illness triggered serious asthma. She checked in, gasping for breath. She was prescribed antibiotics and asthma medications, referred to her primary care doctor—and then over time, a pulmonologist, ENT, and neurologist. Each specialist had only their own narrow scope; no one had the wide view to pin down what was triggering the cough and respiratory arrest. She reentered the healthcare system through the ER a half dozen times within four months. Still no answers. She continues to wait for the next episode, results of more tests, and the inevitable new referral. This is not only an inefficient utilization of the healthcare system, but there is a toll on her life and job performance.
Who is helping to prevent these circular situations from developing and overseeing the whole person? Do we really have anyone in the healthcare system that can advocate and manage the health of an individual?
These are important questions to ask as we evaluate the messaging to employees. Today, we’re encouraging employees to develop a relationship with a primary care provider who we have been told will help coordinate our employees’ healthcare needs. But are our primary care doctors including internal medicine doctors and family practitioners trained to take on this role? Do they have the resources, time, staff, and knowledge to be that quarterback? We’re “training” our people that primary care means the doctor is the primary point person. But is this really the case?
Back in the day, there were community doctors—yes, the ones that often made house calls. They were the healthcare jacks-of-all-trades. They had to know a bit of everything. Their knowledge spanned specialties because there weren’t so many dedicated experts that focused on just one aspect of medicine. They could treat an array of issues.
The more we examine this issue, it seems there is a missing role in the modern system—a quarterback, an advocate, a manager of health that is missing from the patient’s resources. Someone like the traditional, broad-based doctor expert. How did we get to a place where the ER became the primary “doctor?”
This is not an overnight healthcare system challenge. It’s been building up over time. The pandemic certainly exacerbated the situation by digitizing processes, and there have been positive outcomes because of this, including greater access. But with this, we lose the ability to pull everyone into a conference room for a training opportunity. And meanwhile, we’re experiencing a significant doctor shortage. According to the Association of American Medical Colleges (AAMC), the U.S. faces a projected shortage of 38,800 to 125,000 physicians within 12 years, according to the report The Complexities of Physician Supply and Demand: Projections from 2019 to 2034.
There are many pieces and parts contributing to the breakdown in the healthcare consumer experience. And it’s costing us more than dollars. The specialist visits, ER trips, time, and stress are more than any of us can really afford. What can we do to change outcomes as employers?
Maybe what we need to be doing is encouraging employees to be their own healthcare advocates—to learn, to challenge, to ask questions. Seeing an emergency department doctor or multiple specialists for specific ailments and issues is not a whole-health approach. The most effective way to be your own advocate and manage health is to adopt behaviors that prevent doctor visits in the first place: stress reduction, a healthy diet, regular exercise, getting enough sleep, and spending time with family and friends. Maybe the missing role in our current system needs to fall on us as individuals.
Share your experiences with us. What will you do to help employees navigate a system that’s more specialized, digital, and short-staffed than ever before? The one thing we do know is collaboration is essential and it starts with asking questions.
About Health Action Council
Health Action Council is a not-for-profit 501(c)(6) organization representing mid-and large-size employers that enhance human and economic health through thought leadership, innovative services, and collaboration. It provides value to its members by facilitating projects that improve the quality and moderate the cost of healthcare purchased by its members for their employees, dependents, and retirees. Health Action Council also collaborates with key stakeholders – health plans, physicians, hospitals, and the pharmaceutical industry – to improve the quality and efficiency of healthcare in the community.