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