Connecting The Dots of Healthcare

Becoming a physician is a daunting challenge. The amount of science, (that changes significantly every five years), to digest and apply to create clinical excellence is a herculean task. But clinical excellence, alone, is not enough to succeed in the “business.”

As a healthcare consultant I stress the balance between clinical excellence and patient satisfaction. The balance between clinical and caring, between science and art, between high tech and high touch. The ying and yang of medicine.

As the science is taught formally, so must the art be taught. I don’t recall any segment of the yang on the MCATs other than the “general knowledge.” Sure, there was the “interview” for medical school admission that included some yang stuff. But I do remember, vividly, a professor emeritus once lecturing on the sanctity of the physician patient relationship and respect for patients. Even though it was only ONCE, I probably remember his lecture as well as any other specific lecture in medical school. But that was it.

Being successful today in medicine requires more than clinical excellence. In addition to the “patient satisfaction” measures now being dutifully rated by Medicare with HCAHPS scores, (that will evolve to specific physician measures too), we must also learn how to, and be responsible for, maintain a regulatory compliance correct “business of medicine.”

Degrees of comfort vary from student to student with regard to the meeting emotional needs of patients or looking realistically at medicine as a “business” as well as a “practice.”  But everyone, even one classmate who coudn’t stand the sight of blood, (she became a psychiatrist), had to take classes that were, well, bloody. When  the capacity for many academic medical educators to demonstrate and mentor both the ying and yang themselves may be limited, makes it even more difficult, but all the more necessary.

A few years ago a group inquired about me to visit as a speaker to a resident staff at an august medical school. They called to take the hold off a date they requested and told me the residents had decided not to go with a “business of medicine” topic but rather focus the entire lecture series on clinical topics. It’s like letting a kid choose to eat candy for meals rather than a balanced meal. It’s a mistake to ignore the yang of medicine.

As hungry as we all are in perfecting the clinical tasks of patient care, there simply is more to success than the clinical excellence. We must all learn to balance a variety of patient, payer, hospital, and a myriad of other “dots of healthcare” needs in the increasingly complex healthcare ecosystem we find ourselves in to become truly outstanding physicians.

To a degree, clinical excellence is a given and assumed by patients. Once you’ve got the right initials after your name, most patients don’t want to know how much you know, they want to know how much you care. Assuming you’re not falling off the bottom of the standard deviation measure of care, they’re not interested in how “good you are at medicine,” they’re more interested in “how good you are at who you are.”

So when medical students and medical schools roll their collective eyes at a formalized course on ethics, caring, business, and other “non-clinical” disciplines, accept it and make ‘em take the course, just like we had to take statistics. (Now there’s a set of lectures I can’t even beginto remember.)  

I’ll bet the most memorable lectures thirty years after graduating medical school will not be the ones on the ying of medicine, (that changes every 5 years as our knowledge base grows), but the ones on the yang.

The lessons I learned from that one professor emeritus are still as applicable today as they were when I first heard them. Science changes. Humanity changes much more slowly. Both the ying and the yang are essential for medical education.