Hardworking Docs Will Only Get Us Partway to Health Reform


Dr. Atul Gawande’s recent article published in Monday’s New Yorker, is a collection of hopeful tales featuring hard-working health care providers. The piece highlights doctors, nurses, and ancillary providers (health coaches, medical assistants, etc.) who spend less, despite - and because of - treating the sickest patients. With these vignettes Gawande suggests that health care providers like these will lead in bending America’s health care cost curve.

Since Gawande has a history of influencing decisionmakers, some think this article will prompt other innovators to develop ways for providers to save lives and dollars. Others, like me, are less bullish and think Gawande reports on inspiring, but unsustainable models of care.

In one of Gawande’s vignettes, a doctor coaxes an obese patient to drop 200 pounds, put his hypertension and diabetes in check, and overcome drug and alcohol addiction. In another, a once wheelchair-bound patient thanks a health coach for pushing her to exercise and take yoga classes. Other providers enter their clinic phone number in patients’ cell phone speed-dials because the patients admit they don’t know how to save contact information and default to calling 911 for any urgent medical concerns.

In these accounts, a provider pushes high-cost patients toward behavior that reduces health system expenditures. Losing weight allows the formerly obese patient to pick himself up after falls rather than call an ambulance, for example. This is the key to bending the cost curve - providers and patients collaborating to find health care solutions in a resource-limited environment.

Unfortunately, Gawande’s article focuses too much on the provider’s role in this relationship.

By highlighting the provider that makes house calls, spends hours at patient bedsides, and finds free time to make maps predicting where his next patient lives, Gawande glosses over the important actions the physician’s patients must take to achieve good health at low cost. Without patient involvement, the practices that Gawande profiles would fail as their hard-working providers sped to burnout.

The lack of attention paid to patients’ duties in health care is unfortunate because in America, we eat too much, smoke too much, and don’t exercise enough. We’d rather go to the doctor for a quick-fix than hear a health coach recommend yoga classes. The spotlight should shine less on wunderkind providers and more on patients demonstrating personal accountability and behavior change.

To bend the health care cost curve in America we need more than hard-working providers. We also need hard-working patients.

Gawande talks back to critics and allies alike in a follow-up post here. Do you agree? Comment below.

Photo Credit: Tobyotter