“Patients encounter the healthcare system, physically, socially, psychologically, emotionally, financially and for years, decades, eons, we have sat very comfortably in the chair of “We’ll take care of the clinical stuff, the rest, you’re on your own. Well, I think not.”
Jack Cochran, MD, author of Healer, Leader, Partner (2018)
Physicians as healers
I became a doctor to help people, and chose general practice as my specialty because I recognised gaps in access, quality and cost of health care. Somewhere along the line, I began to see the frustrations that my colleagues experienced regarding a health system that was fragmented, and did not necessarily work together to meet the needs of their (our) patients. In stark contrast, patients were telling me that they often did not feel heard, did not fully understand decisions made regarding their health, and were not feeling respected as active participants in their own health care.
“…I knew something needed to change.”
Dr Jack Cochran’s new book packs a punch and delivers lessons learned from an inspiring career in health care. He encourages physicians to step into the role of healer, leader and partner and describes each role with powerful examples.
Every day, numerous miracles take place in health care, made possible by advances in medical knowledge, education, technology, and the incredible training and experience of today’s health care teams. Numerous studies have demonstrated that at the frontline of health care, exceptional general practice improves health outcomes and empowers patients and their families to live happier and healthier lives.
However, the irony is that patients, their families and carers consistently report not feeling heard, not fully understanding the decisions made around their health, and not being made to feel as though they are active participants in their own health care. Our patients, in their involuntary roles, expect us to opt in on their behalf, as leaders, for “all the ways the system impacts them, including quality, access, equity, affordability, and safety” (Jack Cochran, MD, Healer, Leader, Partner, 2018). This is what we signed up for.
Physicians as leaders
Dr Cochran states that doctors must consider their roles outside of the four walls of the consult room.
“…physician as leader says actually that I’d better opt in on more issues for healthcare than just my exam room, because there is a lot of ways patients didn’t have healthcare go well… It starts to say I’m going to participate in…quality improvement, learning about IT systems, performance management, scientific breakthroughs, those kinds of things.”
Leadership is not an easy pill to swallow. When you realise that there are better ways to do things, and your efforts are met by friction across the social, economic and political landscape, this leads to an often insurmountable feeling of intense frustration. There are theories behind why this is the case. Perhaps the one I relate to most is the ‘Managing Complex Change’ Framework:
Even in the presence of vision, skills, incentives and an action plan, lack of resources leads to frustration. We have seen this time and time again in health care, and it is something we must get right in order for meaningful change to occur. However, it is quintessential that we get the other elements of change right, and as health care budgets are limited, consider how resources can be allocated more effectively. We don’t necessarily need more, but we do need different.
Different can be as easy as recognising that the old adage of “one doctor, one chart, one exam room, and the computer was the physician’s brain” no longer serves us. It is a shift towards physicians accepting that they may reach their goals more easily by working as part of, and leading, teams. In the face of burnout and overwhelm in the medical profession, the statement below by Dr Cochran really hits home:
“We must remember the power of our teams and the support system they can provide to us. Our teams can recharge us by listening, understanding, providing counsel, and being there for us when we need a lot of courage. Leaders do not have to go it alone.”
So not only do “many minds make light work,” working together also has the significant potential of increasing joy in work and physician well-being.
Physicians as partners
Today’s physicians must take responsibility for partnering with patients to positively influence the health care system. What we do within our consult rooms is only a small part of our overall role. We must “embrace the role of healer, leader and partner, and approach [our] roles with the same commitment and generosity of spirit with which [we] signed up to become physicians so many years ago.” (Jack Cochran, MD. Healer, Leader, Partner, 2018).
Dr Cochran goes on to describe the role of doctors as partners, and encourages us to consider our limitations, as well as the benefits of collaboration.
Physician as partner says, “I’ve got to learn to be more of a team player. I’ve got to work with nurses and pharmacists in much more collaborative ways because I can’t just do everything based on my own brute strength of my training and my intellect.”
Collaboration is an area in which health care teams are increasingly dabbling. However, professional and systemic barriers to working together remain. Leaders must unite around common, shared visions and more than ever before, it is vital that health care consumers occupy key seats in discussions around the evolution of health care – “Nothing about me, without me.” In an industry in which all that we do directly affects the well-being of our patients, we are yet to fully comprehend how we can work effectively with our patients to effect meaningful change.
In his book, Dr Cochran speaks of the history and culture of medicine, in which physicians are encouraged to function individually rather than as a team. The overly competitive nature of the profession “run(s) the risk of duplicating costs and taking unfocused, inefficient action.” Duplication and oversupply are often major cost drivers in health care.
Organisations such as Consumers Health Forum are paving new pathways for consumer engagement, and the Shifting Gears – Consumers Transforming Health White Paper (2018) is an informative exploration of what we can be doing better.
The inherent challenge with working together in a fee for service environment is that we are funded based on volume. Health care organisations make budget submissions based on increasing (or at least maintaining) the level of funding available to the related profession. Considering the Managing Complex Change framework, we may appreciate that lack of incentives for us to work together trigger resistance to collaboration. Pooled funding models may be a helpful solution and have lead to the implementation of successful models such as the Western Sydney Pharmacists in General Practice project.
New ideas must be critically assessed. Partnerships with universities and other academic institutions allow health care systems to embed new projects within rigorous evaluation frameworks. This is a valuable mechanism, and assures key stakeholders, such as patients, clinicians, health sector leaders and governments, that what we are doing has been properly validated. In other words, this is what makes change ‘meaningful.’
So what next?
I encourage you all to read Jack Cochran’s new book, Healer, Leader, Partner, and reflect upon your current role in influencing the health care system. What do you see as your role? Could you be doing more?
You can purchase the book on Amazon.
You may also enjoy Dr Cochran’s interview with Charlie Hoehn on Author Hour, from which I have borrowed many of the quotes for this article. Click here to listen or read the transcript.
Please don’t hesitate to leave a comment and let me know what you think.