For years health care has been caught up in the notion that we can be better business entities if we pursue the principle of “economies of scale.”
“We can have one person answer the phones, another do the check-in….” It all seems to make so much sense – I mean, isn’t this efficient?
We see large practices that have many staff and have large waiting rooms (more economical than several small waiting room, right?). We have billing staff, referral staff, managers to help manage the staff.
Because of all the people, we have to hire human resource staff as well. We purchase an EMR so that we can code better and wring every blasted penny we can out of the insurance billing craziness.
What gets lost in this? The people we serve. We become institutions and the care becomes impersonal. We then struggle endlessly trying to get “patients” to be “compliant” with our wonderful evidence based guidelines and protocols. “I have this 60 year old diabetic that just won’t listen to me – I am just so tired of this non-compliance!”
We have sacrificed the people we serve on the altar of ‘economies of scale.’ When we wake up from the nightmare we have created we have to tear down the walls we have built to keep the ‘patients’ at bay. For our recommendations to have meaning in the complex lives of those we serve we have to slow down and actually listen to people.
The benefit of knowing patients as people and treating them with dignity and respect is profound. Economies of scale erode the very foundation of the ethical practice of medicine unless sequestered to parts of our work that do not impact the personal relationship.
L Gordon Moore
Would like to be added to e-mail
Posted by: Natalie Berlin | July 08, 2009 at 03:37 PM
Great post!
As a solo in Western PA for the last 4+ years, I have seen much change, yet still patients flock to my solo practice.
Although I now refer to a colleague for my inpatient practice, I enjoy more and more the practice of family medicine after 20+ years now.
Agree with Gordon.
Would add the concept of "anonymity of care" where a patient, a doc, meet in an office neither one have been in, to have a visit using computer assist. This is NOT ideal!
Dr Matt Levin
Solo FP since Dec 2004
Residency completed Family Medicine 1988
dr-levin@comcast.net
Posted by: Matthew Levin, MD | April 17, 2009 at 03:40 AM