If you want to discourage a worker, subject them to policies and procedures that don’t make sense. This principle was first described by Frederick Herzberg, an American psychologist who developed one of the most widely studied theories of workplace motivation. Unfortunately, Herzberg’s principle is being widely applied today in medicine. Changes in healthcare payment systems, the use of information technology, and the doctor-patient relationship have left many doctors deeply discouraged.
Consider three specific examples. A physician who could provide care for a pediatric patient over the phone asks the mom to drive three hours each way to the office, because he can get paid for an office visit. A physician taking a patient’s history points and clicks a computer form to record information, but recognizes that many parts of the patient’s story will be lost because they don’t fit the template. A physician trying to learn more about a patient’s prior hospital admission can’t find the information she needs because the record is an example of “note bloat,” overflowing with big chunks of information that were cut and pasted from day to day, but containing little of real use.
It is easy for many healthcare leaders to forget that doctors go into medicine not because they enjoy entering data into complex electronic health records and ensuring that their employer gets paid for everything they do, but because they want to make good diagnoses, prescribe appropriate treatments, and help patients.
I recently spoke with Dr. Paul Weygandt, an orthopedic surgeon who is now vice president of physician services at a medical communications firm. Early in our conversation, Weygandt expresses a sentiment shared by many contemporary doctors when he describes the way his father, also an orthopedic surgeon, practiced medicine decades ago. In short, his father never filled out any insurance forms, meaning that he could not be directly paid by insurance companies.
With a substantial chunk of income at stake, why wouldn’t the elder Weygandt take steps to ensure that insurance companies could pay him? Simply put, he believed that by allowing an insurance company to come between him and his patients, he would be turning over medical decision making to a stranger. In some cases, he never received any of the reimbursement insurers provided his patients, but he regarded this as a price worth paying to provide the type of care he believed in.
The younger Weygandt believes that contemporary medicine has allowed too many intermediaries—financing, technology, and the way practices are structured—to come between patients and doctors. Too much time is focused on generating revenue rather than quality. Too many technological systems are built in ways that make sense to computer engineers but not to doctors. And too much time is spent pointing and clicking rather than capturing the essence of a patient’s story.