I recently stumbled across a blog post by Dr. Jay Parkinson, an entrepreneur and founder of Sherpaa, who reflected on a recent private breakfast with New Yorker and best selling author Dr. Atul Gawande. The question posed by Gawande: Can technology be a change agent for health care? From Parkinson’s blog post, the response is: The inevitable answer is yes, with one important caveat. It’s not the technology that will change the practice of medicine, it’s the doctors who use the technology who will end up changing it. And it won’t come overnight. Many of the most influential doctors practicing medicine today have an antagonistic relationship with computers. Change will only come in a massive way when the under-40 generation takes control. Under-40s expect technology as impressive as Facebook, twitter, kayak, and tumblr to influence each and every moment of our practice. My generation simply doesn’t know how to live […] Read More »
Author Archives: Davis
The Seven Pillars of High Performing Primary Care Practices – Part One
Posted on November 27, 2013
In a previous post titled, “Is Making Primary Care More Professionally Satisfying as Simple as Lowering Panel Size” I observed that lowering panel size and implementation of an electronic medical record did not change how doctors worked. Those doctors who stayed late continued to stay late. Those who left earlier tended to continue to leave earlier. Within a health care organization often touted by many to be an example of how health care should be delivered in the country, this phenomenon existed. Why? Was making primary care more professionally satisfying and more attractive to future doctors simply more than lowering panel size? Doctors at the Permanente Medical Group, where I practice, do not have many of the frustrations of other primary care doctors. Doctors are salaried. There is no perverse incentive of doing more tests or more procedures when there is no medical benefit. Doing more is a common pressure […] Read More »
Is Making Primary Care More Professionally Satisfying As Simple As Lowering Panel Size?
Posted on November 3, 2013
As a practicing primary care doctor, I very much enjoy my career choice. I’m fortunate enough to be in a large multispecialty practice that is collegial and forward thinking. If I was in a smaller practice like other colleagues, I would not quite feel the same. Yet concern about how to make primary care attractive for both future doctors and those currently in practice has been something I’ve been occupied with since 2010. It is simply about lowering panel size? Though that may help, the answer is more complex than that. In this post and a future post, I ask that question and propose a framework on how primary care can be better and how physician leaders might best address the problem. In 2006, my medical group transitioned to an electronic medical record (EMR). Interestingly, nothing changed on the amount of time doctors spent in the office. After becoming more […] Read More »
Why Doctors Should Read Malcolm Gladwell’s David and Goliath. Can a David Fix Health Care?
Posted on October 16, 2013
October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare continued to march forward with the opening of the insurance exchanges. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath. Gladwall ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? When might a disadvantage for an underdog appear to be an advantage? As I put his observations together, I wondered are there any learnings for doctors and the health care system? Absolutely. A David typically does not have the resources or power to make a difference as viewed by conventional terms. Gladwell uses stories like the US civil rights movement, successful individuals with a dyslexia, and his excellent New […] Read More »
The problem with health insurance exchanges. The risk for patients. Pension plan to 401k analogy.
Posted on October 3, 2013
With the implementation of health insurance exchanges in October 2013 and the beginning of the Affordable Care Act (ACA), also known as Obamacare, there is tremendous risk for the American public to be worse off. Certainly the millions of Americans who currently are uninsured because their employers do not offer insurance coverage and those with pre-existing conditions unable to purchase affordable individual coverage, will benefit. It is those with employer based insurance coverage who may lose. They just don’t know it yet. Employers have found it difficult to absorb the rising health insurance premiums and costs, which have increased faster than inflation. They have tried many ways to slow health care spending including requiring employees to have more “financial skin in the game” to encourage them to make “smarter” choices about their health care. They’ve done this with higher deductibles and co-pays and requiring employees to pay a larger percentage […] Read More »
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