December 17, 2014

Rethinking the practice of medicine

Team-Based Care: Saving Time and Improving Efficiency

When two years ago Eric Topol published a book on "The creative destruction of Medicine", many people thought it was a provocation. He was just borrowing the term keyed by Joseph Shumpeter for the economy as a whole. However, his message in my opinion still falls short. He was focusing strictly on changes that rely on technological innovations and he forgot organizational innovation.
Now, have a look at this recent article at FPM 
Drs. Hopkins, Sinsky and Peter Anderson all state that most outpatient visits can be divided into four distinct stages: 1) gathering data, 2) the physical exam, 3) medical decision-making, and 4) patient education/ plan of care implementation. Rather than the physician being responsible for all four stages, they recommend that a clinical assistant (a registered nurse, licensed practical nurse, or highly skilled medical assistant) perform the more clerical stages, one and four, while the physician focuses primarily on stages two and three. The clinical assistant stays in the room with the patient during the entire visit, gathering the history and doing all the documentation. The physician joins them for stages two and three before moving on to the next exam room where a second clinical assistant has set the stage by performing stage one. This allows the physician to see more patients, thus covering the costs of additional clinical assistants.
This proposal requires coordination and a reallocation of resources, roles and tasks. In certain diseases such a model has already been implemented. Is anybody able to extend it and amplify its impact on efficiency of the whole healthcare system?

PS. FT books of the year

PS. In UK some hospital mergers are prohibited. What a difference on the rule of law compared to ours!