Doctors are now more facilitators than “sages on the stage”
(York) — Health care is no different from any other industry. As the saying goes, there’s only one constant.
“I think changes have always been happening,” says Christine Everett, assistant professor at the Community and Family Medicine Department at Duke Medical School. She’s monitoring what’s being shifted away from doctors and towards other medical professionals.
“Ten years ago, we were in a different world. We were coming off of managed care, by and large at that point, the focus really was for physicians to do patient care, to really focus on the individual patient in front of them,” says Everett, who has seen the changes first-hand, as a physician assistant.
Wellspan’s Dr. Mathew Howie, Medical Director at the York Hospital Community Health Center, is old enough to remember the days when x-rays were read off of films, and prescriptions were hand written. Now, virtually everything is on some type of screen: maybe it’s a tablet, maybe it’s a desktop computer.
Wellspan’s Dr. Matthew Howie can also understand Spanish, making his job as a “facilitator” even more critical.
It offers a more complete picture of a patient, but also adds time. And so, he says he’s delegating some tasks to nurses or medical assistants in his office.
“I’ve pre-reviewed these and said for individuals that meet this criteria, we will do vaccines based on a standing schedule, unless we divert away from the schedule. That allows vaccines to be given much more consistently. It takes some of the control away from me.”
Don’t forget, doctors are still doctors. Howie asked the usual questions, like “When did the pain start for you?”, “Where does it hurt?”, etc.
That being said, advances in technology have given Howie more tools, and required more coordination
What’s pushing all this change? The Affordable Care Act, for one.
But also an attempt is underway to stop the rise of health care costs by keeping people healthy.
It’s now a team effort — primary care physicians can work with all of these, and more: PAs, LPNs, MAs, RNs, NPs, pharmacists, health coaches, mental health counselors, specialists.
It’s a lot of different people, to be sure. Howie says other staff can do many of the tasks a doctor can, and at lower cost.
“They are seeing more people than they’ve ever seen involved in their care. My patient knew she had talked to a person from my office, but she couldn’t identify her as the health coach. It was just a person reaching out to me.”
Reimbursement for coordinating care, health coaches, and other services has started to catch up with innovation, because while most doctors want to do the best for their patients, they need to be able to stay afloat.
With all the teamwork, that leaves a physician to do only what he or she can do, and as weird as this sounds, Howie says that can require an adjustment.
“And it is a sacrifice, because you’re sacrificing what you’re comfortable with, you’re sacrificing what you know, and you have to trust that the progress and the changes that are occurring are actually moving things forward.”
Dr. Karen Jones, chief medical officer for the Wellspan system, recognizes how all this change can be challenging for a physician to undertake. After all, she sees patients herself, and has had to change her mindset. Instead of being the “sage on the stage”, she’s right there with the patient, hearing them out.
“Now what it is saying, is so what’s important to you, so that then you can tie that in to those important medical things that need to be done. So they’re spending the time on it, but instead of telling people, it’s asking them and then tying it back.”
Let’s be real here for a second.
Doctors are often Type A personalities.
They don’t like getting told what they’re doing is wrong. Most of us don’t.
So getting them to try something different can be pretty hard, but when the data is front of them, well, that changes everything.
“It allows them to have a window into another perspective, of okay, I thought my patients and I were doing well on this, and maybe we’re not doing as well as I thought,” says Jones.
“And then when you compare it, then it allows the physician to know what’s possible. Oh I thought I would never achieve that or could never achieve it.”
In the end, she says it’s about a common thread running through the time a patient walks into the examination room until they leave.
“So just to go back and say my goodness, are we speaking in a way that people understand.”
As Dr. Matthew Howie wraps up his time with a patient in York and dictates into a special device that quickly and accurately turns spoken words into paragraphs on a page, the doctor speak is gone.
He grabs what he just dictated from the printer and hands it to his patient, because he’s now a facilitator.
Authored by witf reporter Ben Allen, this article initially appeared on witf.org.
