Patients Want Symphonies, Not Mashups

Recently I saw this tweet from one of my mentors, Casey Quinlan, better know as @MightyCasey.



This Tweet struck a chord with me. I have spent the vast majority of my career focusing on projects that allow me to compose a duet between the questions being asked and the answers generated by healthcare teams.

In a September 22, 2015 article entitled, “Urgent Change Needed To Improve Diagnosis In Health Care Or Diagnostic Errors Will Likely Worsen, Experts Say” published by the National Academy of Sciences, Engineering, and Medicine states the following:

“Improving diagnosis is a complex challenge, partly because making a diagnosis is a collaborative and inherently inexact process that may unfold over time and across different health care settings.”

The article also recommends that in order to improve the difficulties in making a definitive diagnosis that there needs to be more focus on the effective teamwork between patients, physicians, payers, and politicians. (The article listed patients after physicians I am taking the creative liberty to make the correction)

In a separate but related article in the BMJ entitled: “Physician Spending And Subsequent Risk Of Malpractice Claims: Observational Study” it is observed that there are fewer malpractice claims associated with an increase in “resources” spent per patient.

Falugn Tweet

As you can see I was tagged in this Tweet by Dr. Falgun Chokshi. (@FulgonChokshiMD)((honorable mention @RichDuszak))

The comment,

“…major reason it’ll be very hard to lessen #imaging volume despite #cms mandates. Value goes both ways….”

made me pause for several days.

Yes we live in a world of defensive medicine. Yes we live in a culture of reality TV, get rich quick schemes, and many people want to live like the Kardashian’s.

We live in a time in which our pay is directly proportionate to the amount of work we accomplish. (in many cases)

My premise remains the same.

The only way we scale change is one patient, one physician at a time.

Physicians do not see 100’s of 1000’s of patients at the exact same time.

Physicians see one patient at a time. The N of 1.

It doesn’t matter if you are a primary care physician, an internal medicine physician, a gynecologist, a proctologist, a neurosurgeon, a pathologist, a radiologist or any other physician you can name, you only can see one patient at a time.

If that is the case, it is imperative that we co-create spaces and opportunities for patients and physicians to connect.

Patients have a responsibility to be open, honest, and forward with their physicians. Patients need the appropriate amount of time that allows them to have trust in their physician(s) and care team so that they can be completely transparent with their signs, symptoms, choices, and questions.

Physicians have a responsibility to listen and document the notes and address the concerns of their patient while being able to formulate the right question to be asked.

Once the question is defined, then the right team needs to cooperate to get the right answer for the patient.

When a radiologist is ready to review a set of images it is beneficial to understand how the patient presented, what their complaint(s) are, as well as lab values, medications, and other previous history of illness or images.

The problem exists when we fail to first listen to the patient. When we listen we can define the right question to be asked. When we ask the right question, we can select the team needed in order to orchestrate the best possible answer.

Not everything and everyone, but the right things and the right people.

To make this happen, independent of where the patient begins and ends, someone needs to be the conductor.

The conductor can manage the transitions. The information coming in and going out; the timing and coordination of the workup for the patient and care team; the communication of the answer between members of the care team; delivering the right answer to the patient.

When the transitions happen in a well timed out manner by a trusted team what they are able to produce is a wonderful symphony to the patient.

Healthcare is full of mashups.

I prefer to co-create symphonies. (or rap, or rock, or jazz, or country if that is what the patient prefers…well maybe not country)

As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek


P.S. In honor of symphonies……

2 responses to “Patients Want Symphonies, Not Mashups

  1. again Andy, we’re speaking the same language. I have learned so much from Casey too. So many good insights here. Keep up the good work 🙂

  2. What we have all failed to consider is that we are relying on the clinical judgment and minds of physicians and often fail to use the enormous power of computer for information retrieval and symptom matching to the full range of possible diagnoses based on the patient symptoms and characteristics. These tools can help determine what are the probable diagnoses, the urgent diagnoses (those not probable but needing urgent action to resolve to avoid severe morbidity or mortality) and the tests to rule these in or out. No one human being can remember the full extent of possible medical diagnoses and treatments. Using computer based information tools will improve diagnoses, improve outcomes and reduce costs as diagnostic tests will be done on a systematic basis and not on a defensive (to avoid malpractice) or an ad hoc (intuitive) basis. See “Medicine in Denial” Lawrence Weed and Lincoln Weed.

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