By Pamela L. Wible, MD
Dissatisfied with assembly-line medicine?Dreaming of life off the hamster wheel?
Don't wait for politician-saviors. Convene with your neighbors.
Physicians nationwide are taking a novel approach to healthcare reform: They're listening to citizens. All across America doctors and patients are joining together to create ideal clinics, hospitals, and regional healthcare systems based on the real needs and wishes of the communities they serve. Could the future of American health care begin in your own backyard?
Physician as Public Servant
Americans typically rely on elected officials to uphold the will of the people, and for decades partisan struggles have prevented meaningful healthcare reform. Given current repeal efforts, outcomes are never guaranteed. But now physicians—traditionally confined to our exam rooms—are taking direct action to fulfill community needs.
In 2004 an epiphany led me into neighborhoods to meet face to face with citizens in my hometown of Eugene, OR. I thought, "Why wait for legislation? Why wait for another election? I'm an MD, fully licensed, board-certified in family medicine. What's stopping me from serving the public?"
I began by hosting town hall meetings and inviting ordinary citizens to help me create the clinic of their dreams.
From living rooms and Main Street cafes to neighborhood centers and yoga studios, I met directly with people and listened to their wisdom. Bus drivers and businessmen, housewives and healthcare workers, teachers, college students and folks of all ages gathered to design a new model, a template for the nation.
I asked each participant to imagine walking into an ideal clinic in an optimal healthcare system. Community-members shared their visions; most submitted written testimony. My job was to implement their ideas where feasible.
From nine town hall meetings over six weeks, I collected one hundred pages of written testimony, adopted 90% of the feedback, and opened our clinic one month later. For the first time my job description was written by my patients, not administrators.
A Community Prescription
What do people really want from their healthcare givers? Surprisingly, it’s nothing too extravagant. Here are their top ten recommendations, many in their own words:
1. Real relationships: People want practitioners who are fully present and willing to touch them emotionally, spiritually, and physically. One woman's simple request: "Hug me!"
2. Physician role models: Happy, healthy doctors inspire patients to live happy, healthy lives.
3. Integrative healing: People want all healing arts professionals to be working in concert for their wellbeing. They also want easily accessible, on-site complementary therapies such as massage, yoga, and acupuncture.
4. Sacred space: An ideal clinic is "a sanctuary, a safe place, a place of wisdom . . . a place where we rediscover our priorities."
5. Easy access: Same day appointments offered and everyone receives care when they need it.
6. Relaxed appointments: Visits are, at minimum, thirty minutes. Patients want to be able to speak uninterrupted and "feel heard, understood, and cared for."
7. Patient-centered care: One citizen's advice: "Abolish cookie cutter medicine—everybody does not need the same thing."
8. Community orientation: Patients want a doctor who is part of the community and "knows everyone by their first name . . . knows patients in a social context."
9. Creative financing: Offer your patients an array of different payment options: Consider monthly stipends for services. Offer sliding scale discounts. Accept donations, bartering, and insurance when possible.
10. Heath education: "Transition from an acute care delivery system based on intervention to one of continuing education of all possibilities of health and wellbeing."
What Ideal Healthcare Looks Like
By soliciting community input, I was able to design my clinic to best serve my patients' needs. My practice model enables me to spend time getting to know the people I serve.
By following my community’s instructions and indications, I now work in an ideal clinic. Our cozy office is housed in a wellness center tucked into a wooded residential area. Yoga, massage therapy, counseling, and a solar-heated therapy pool with hot tub are available on-site. Before appointments, patients may relax in the hot tub instead of a waiting room. Then a short stroll along a walkway leads to a living-room-style office with overstuffed chairs and pillows.
With no administrators or staff, patients enjoy direct 24/7access to their doctor by phone and email. Appointments are thirty to sixty minutes long, scheduled on weekday afternoons and evenings. Sessions begin on time—guaranteed—or patients get to choose a present from the gift basket. I do accept most insurance plans. Uninsured patients receive a 30% discount for payment-in-full at time of service. Alternatively, patients may trade skills such as massage or donate handmade items to the gift basket. Nobody is turned away for lack of money.
A Populist Movement
Open since 2005, our model has inspired many other physicians to recapture their dreams and reinvent their careers by collaborating with citizens to design innovative clinics. Hundreds of ideal practices are now open nationwide.
Inspired citizens and loyal patients rally around these novel community-designed practices: Volunteers donate hand-sewn flannel gowns; Citizens mail unsolicited checks; Patients assist with billing and office work. It’s quite amazing what happens when patients and physicians actually work together!
Now hospitals are joining the movement. In October 2010, a hospital system in western Wisconsin—inspired by our clinic—invited citizens to design their dream hospitals. The desires of disenfranchised groups—from school kids and the elderly, to the Amish community and Hmong immigrants—were specifically sought and embraced.
Over one thousand people attended events, sharing heartfelt visions through written and verbal testimony. The hospital even had children submit drawings. Implementation is now underway, and as America's first dream hospital becomes reality, more and more hospitals will follow its lead.
What's they key to delivering ideal health care? Put patients--not politicians or corporations--in charge! Why wait for Washington? Follow Wisconsin.
A Cure for Frustrated Physicians
My parents—both physicians—warned me not to pursue medicine. Today, my colleagues continue to steer young people away from a career in medicine. Why? Here's a partial list of grievances: low reimbursement, loss of autonomy, patient overload, loss of respect, the malpractice crisis, bureaucratic red tape, corruption. At a time when America is in greatest need of primary care physicians, our numbers are decreasing (See Escape From McMedicine)
According to a survey by the Physicians’ Foundation, half of all primary care docs have considered leaving medicine (The Physicians' Foundation Survey, Merritt Hawkins & Associates. November 2008.). Some transition into pharmaceutical or insurance company positions. Others opt for administration or early retirement. In my last employed position at a five-physician practice, four female physicians left medicine to pursue teaching, homemaking, waitressing, and other "more meaningful" careers.
Most who don't escape become victims. Three quarters now believe medicine is less rewarding or no longer rewarding, and claim they are overextended, overworked, or at full capacity. Many physicians—having lost their dreams, their inspiration for practicing medicine—simply function in survival mode.
So what's the solution?
Singer Joan Baez once said: "Action is the antidote to despair." Physicians are in a unique position to bypass partisan discord and enact real change. I believe it's time to step out of our offices and embrace our communities. I realize doctors don't usually ask for help, but sensible solutions are literally right next-door. I looked everywhere for answers, but it was ordinary citizens in my hometown who came to my rescue. They designed our clinic, saved my career, and helped me find a way out of my misery.
I invite you to talk with your neighbors, to engage with your community, and most importantly, to act on what they tell you!
Ideal clinics: http://www.idealmedicalcare.org/ideal-clinic.php
Ideal hospitals: http://www.idealmedicalcare.org/ideal-hospital.php
About: Pamela L. Wible, MD is a pioneer of community-designed medical practice. Her model has sparked a populist movement that has inspired the creation of Ideal Clinics & Hospitals nationwide. Her community-designed model is featured in the Harvard School of Public Health’s newest edition of Renegotiating Health Care: Resolving Conflict to Build Collaboration. Dr. Wible's site is at http://www.idealmedicalcare.org