Call the coach & get off the 'medical hamster wheel'

Doctors are working harder than ever.

Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place.

That's from an essay on NPR's Shots blog ("Doctors Look For A Way Off The Medical Hamster Wheel," August 14, 2013) by John Schumann, MD, an internist and educator at the University of Oklahoma School of Community Medicine in Tulsa, Okla., who blogs at GlassHospital. 

Like most who get into health care, Dr. Schumann "became a doctor to help people."

When I was a medical student, I held the naive and idealistic belief that if I just did good work, the business side of things would somehow take care of itself.

How wrong I was. 

Now I'm an internist taking care of all comers age 18 and up. Some days I find myself facing patients and feeling more like a harried airline clerk than a real doctor.

The frustration goes both ways. 

Doctors feel they have no time with patients. Patients feel they have no time with their doctors.

Everyone's talking about building a team approach to health care where caregivers "work at the top of their license." That means doctors take care of the sickest patients and other members of the team, such as nurse practitioners and physician assistants, handle more "routine" issues.

But the team needs to go well beyond doctors, NPs, PAs and other nurses. Dr. Schumann suggests an answer may come from Ben Crocker, MD, an internist at Massachusetts General Hospital who once "was so burned out [that] in 2007 he lamented, 'Working at Starbucks would be better.'"

Now, his practice at Massachusetts General Hospital employs health coaches to work with patients on making the lifestyle changes that doctors recommend but can't adequately teach or monitor. Virtual visits — by phone, email or video link — have replaced some in-person visits. Perhaps most incredibly, the practice offers staff downtime each week to come up with innovations.

Sign me up!

A key ingredient here is health coaches — people who work alongside the care team to help educate patients, offer encouragement and improve compliance. This can also include community health workers, or CHWs, who are members of the same community who can often better connect with patients and their families in the places that are most comfortable to them, such as a barber shop, beauty salon or ethnic social club.

If we truly expand the care team — and have everyone working at the top of their game — we can make substantial improvements in patient compliance around treatable, even avoidable, diseases and ultimately improve community health. 

And, in the end, it will save money and make spinning that hamster wheel a little easier for everyone.

Source: NPR