What Is Your Future Of Medicine?

We are holding ourselves back from visionary changes.

The business of our practices and careers often gets in the way of our visionary thinking of the future. In medicine, this seems to be more true than other sectors of our society. Our medical practices of today closely resemble the medical practices of 20 or even 30 years ago.

For the most part, medical practices all look the same. The front door of the practice opens to a waiting room filled with some variety of magazines, chairs and a large glass window that separates the “practice” from the patients. Patients are called back to the exam room and pass through hallways that are narrow and poorly decorated with wallpaper or generic art on the wall. And the exam rooms all look and feel the same: poor natural light and a large exam table placed in the middle of the room.

As well, the process of the medical visit is largely unchanged from decades past. The doctor walks in, sits in her designated chair and speaks with the patient for a few minutes before performing a physical exam and writing prescriptions and/ or lab/x-ray orders. (On a side note, have you ever wondered why the lab report of today looks exactly like the lab report of decades ago? Hasn’t technology changed how we view data?)

We do this over and over. We have been doing this over and over the same way for way too long. One of the problems with figuring out how to create a better health care infa-structure is that we cannot get the current/old/tried-and-true medical visit model out of our brains. We are literally stuck here (and there) because we continually feel that the way we are practicing is the best way because that is how doctors practice medicine. Over and over and over.

I feel that we would do ourselves and our industry a service by throwing away this model and starting fresh. Let’s face it, the modern society we live in right now is very different than 20 years ago. Back then we did not even have the internet, the iPhone or Facebook. 20 years ago we communicated with our patients solely by face to face appointments in our offices. The same offices we are using now.

In order for us to truly make progress, then, we have to reinvent how medicine can be practiced. Here are six visions I have that will make for a better medical practice, improve patient outcome and boost physician job satisfaction (in order from the most practical to the most visionary):

1. Embrace the virtual visit: patients don’t have time anymore to drive through traffic and wait in our waiting rooms and exam rooms anymore. They have questions right now and we have the technology to embrace this. Ask all of your patients to get a Skype account and then offer virtual visits and charge the patient for this convenience. They will love it. And so will you.

2. Take down the glass: this is a pet-peeve of mine. The glass partition creates an immediate sense of imbalance in the waiting room. Far better is to create an open waiting room where patients feel on equal footing with the practice staff. Staff can be trained to communicate so HIPAA violations do not occur. Why not add a pinball machine and coffee bar? Add free WiFi. Make the waiting room a place where patients don’t mind waiting, but actually enjoy the break in their day.

3. Offer Home/ Work visits: This goes back to idea #1. Do you really need a central office anymore? Would you serve your time better by working from home and making periodic house calls while employing virtual visits most of the time? There is so much wasted time in the office. We get interrupted all the time with this phone call or that fax. Wouldn’t your own time be better served if you could focus on one thing at a time? This would certainly free up time to focus on the other aspects of your life and career that you enjoy pursuing. So much of the office is devoted to running the office that many times our own personal goals are left out.

4. Create a Social Health Network: right now this is the big push with out society--belonging, joining and participating in different social media outlets. I think this reflects our desires to connect first. The problem with many of the social media venues is that we end up reaching out as opposed to actually interacting. Facebook and Twitter are great for developing a fan base, but not so good at focusing on the fans. By creating a Social Health Network, we could each have our panels of patients that we could interact with in more of a community way. This would allow us to interact on the individual level and at the community level. Employing a Social Health Network would also allow our patients to interact with each other. I think that having more of a niche network is exactly what people are longing for--more personal and deeper connections.

5. Redesign Lab Reports: have you seen Flipboard on the iPad? This is where we need to move medicine communication. The visual information our current lab reports provide is so boring and plain. There is no visual dimension to these reports. Far better would be to generate digital reports that are fluid and are actually enjoyable for the patient to interact with. Right now we have trained our society to detest looking at their lab reports because they are boring and don’t provide any visual information. But what would happen if we created digital lab reports that were full of color and motion?

6. Merge our virtual health and real health worlds: We are raising our children in the digital era with great emphasis on the virtual world that trumps reality. Video games, streaming movies, iTunes music, apps, you get my point. So why not take advantage of this and create a virtual health world? Much like the Sims game, we could all create virtual profiles of ourselves that we “play around” with. With the advent of monitoring devices on our mobile phones (sleep cycles, heart rate variabilities, pedometers, etc.) it is now easy to access information about ourselves we never could before. We could stream that type of information to our virtual selves: it appears you have not reached deep sleep for 3 nights in a row--how about trying some Melatonin or Ambien? We would then watch what happens with our virtual selves when we tried this. By combining real data into a virtual world, we would be able to see how our bodies react and respond to different tweaks and changes. As doctors, we could then communicate with our virtual patients in this game-like world as well, providing an extra level of support. By combining our virtual and real worlds we would bring an element of fun and style that is currently missing in medical practice.

One of the major obstacles in reforming our health care system is that we are stuck using the same tried and true methods of practicing medicine. I think we will only be able to break through and create a better system for patients and ourselves when we scrap our impressions of how patients are seen and how we practice medicine.

So what are your visions for the future of medicine?

Sky High BMI? Helping Your Patients Lose Weight

By Barbara Berkeley, MD

About 20 years ago, after serving as director of a hospital-based weight loss clinic, I discovered that I was that rare bird, a doctor who was fascinated by obesity. Shortly afterwards, I made the jump from general internist to weight loss specialist. Some would say that this was the equivalent of leaping off a career cliff. My colleagues and friends simply couldn’t understand why I would “give up medicine”. And indeed, a practice devoted to weight management is not quite medicine. It is also not quite psychiatry, not quite nutritional counseling, not quite personal coaching and not quite guru-ism. It is a fascinating combination of each of these things. Despite the professional challenges posed by such a misunderstood field, I feel that I’ve been privileged to spend many years practicing---yes--- medicine at the very center of what ails us in modern America.

Click to read more ...

One Medical & The Patient Experience: Dr. Tom Lee

The patient experience: so many people talk about improving it, but very few people have actually done something tangible about it.

Dr. Tom Lee is a rare exception: his company, One Medical provides an excellent patient experience in primary care. Here he describes the challenges and pitfalls in delivering a better experience, despite the torturous constraints in the American medical system.

One Medical

When Stuff Happens to Physicians

Taking Advantage of Moments When Opportunity Knocks

In his book, Consilience Leadership, Gary Cook, discusses what an inflection point is, what happens when it occurs, and why it’s important to take advantage of it.  The leadership lessons should resonate with us, as physicians in transition—and can be applied in leading our organizations as well as managing our careers.     

As James Kouzes and Barry Posner point out in The Leadership Challenge: “Stuff happens in organizations and in our lives.  Sometimes we choose it; sometimes it chooses us.  It is unavoidable.  What is important are the choices you make when stuff happens.  The question is: When opportunity knocks, are you prepared to open the door.”

Perhaps you’ve been disenchanted with your practice for some time but just haven’t taken any steps to explore other options.  Perhaps you’ve experienced an event in your personal life but are using it as an excuse to avoid making any decisions.  You feel trapped.  Your work life is miserable—but you would rather remain unhappy with what you have than risk a new direction. 

What happens at an inflection point?

An inflection point is an event that changes the way we think and act.  Our patients may experience an inflection point as a result of a cardiac event or near-death experience.  Organizations experience an inflection point when something happens—such as a safety incident, the loss of a market, or a regulatory investigation—that forces a change in behavior.  In both cases, there is a powerful opportunity to create behavioral change, what some might call a “teachable moment.” 

For cardiac patients, the change could be in their diet and exercise routines.  But for individuals in organizations, it could be their interpersonal behaviors, where significant improvement could mean the difference between advancement and being stuck.  It could be a negative event such as a threat of termination or a performance review about not meeting expectations.  The teachable moment can also come out of an experience that “kicks you in the pants” to make you move out of your comfort zone. 

This crucial moment can be the result of an event in your personal life, such as a divorce or death in the family.  Or it can be the result of something in your clinical practice or business that impacts your work, such as downsizing, a merger or acquisition, or a competitive threat. 

Whatever the situation, it cannot be ignored.  It demands our attention. 

The inflection point may prompt questions to guide our self-evaluation.  What’s most important to me now?  Should my goals be different?  Why am I still in the same job or career?  What am I waiting for?

We find we are thinking about an important aspect of our life in a different way—and perhaps, we can change more than we thought.  And we may also find the energy to make it happen.  As Cook notes, “When this process is actuated, a magical moment occurs when we tend to suspend the usual rules about how we manage our lives, and thus we are open to new ways of viewing ourselves and others, and to new standards of behavior.”  Simply put, these moments can create the conditions for introspection and desire for change that might not otherwise occur in our lifetime.

Taking advantage of inflection points

As we all know, it’s not easy to change our behavior.  We set goals for ourselves and then find it’s all too easy to fall back into old habits and behaviors.  We tend to stay with the known and familiar—even if it’s miserable.  Typically, we need a push to get us our fear of the unknown and the uncertain.  Inflection points can create the conditions for that push.

Cook points out that “great moments in history occur when inflection points create a powerful response.”  He cites Kennedy’s challenge to put a man on the moon by 1970 in response to the successful launch of Sputnik and the Marshall Plan, created as a response to the devastation at the end of World War II as prime examples.

Similarly, great moments occur for individuals under such circumstances.  Unfortunately, there are several reasons why it is often difficult for individuals to take full advantage of these points in time. 

• We may not realize we’re at an inflection point—and try to deal with the situation using our normal behavior patterns. 
• We may not recognize the power that an inflection point has to help us change the way we do things.
• We may not be skilled in looking at all of the options available in response to the situation.
• We may not be good at laying out the probable risks and results of new courses of action.

If we are not sure we can arm ourselves with the best answers, it is probably time to consult a professional coach who can help us take advantage of the opportunity created by the inflection point. An experienced coach can help us see the opportunity, sort the options, and unleash the energy of these moments.  A coach can also help us manage the doldrums and restructure the current chapter of our life and begin a transition toward a new chapter (not just going from something—but going to). 

Remember, inflection points happen infrequently, and those who succeed in life tend to pay attention to these points and maximize the benefit of their response to them. 

Concierge Medicine

Here at Freelance MD we get a lot of questions about various trends in medicine.

One of the most rapidly growing clinical practice models in the US these days is Concierge Medicine, and many Freelance MD readers have expressed interest in learning more about this practice model.  

In Concierge Medicine, a physician cuts out third-party payers and contracts directly with his or her patients.  The patients pay a retainer and the physician agrees to limit the practice size so he or she can provide exceptional access to these patients.

While this model has become very popular with a certain segment of the population and many physicians, it is not without critics.  I wrote a recent article here on Freelance MD about the ethics of Concierge Medicine and the arguments for and against this model. 

Since we've received so many inquiries about Concierge Medicine, I decided to post some resources here about the subject.  In addition, for those of you who will be attending the Medical Fusion Conference this November, you'll be able to hear one of the leading experts on Concierge Medicine, Dr. Steven Knope, discuss the subject personally (and have the opportunity to sit down with Steve individually at our Accelerator sessions).  Steve is the author of the book, Concierge Medicine: A New System to Get the Best Healthcare.  

Here's a video interview with Dr. Steven Knope describing Concierge Medicine:

Here's another interview with Dr. Knope that appeared on FOX Business:

Here's a short video in which I describe Concierge Medicine and how we'll be discussing Concierge Medicine at the Medical Fusion Conference:

For those who want further information on Concierge Medicine, check out the following resources...  

Articles

The Ethics of Concierge Medicine by Dr. Greg Bledsoe

The PGA Golf Tour, Concierge Medicine, & Hitting Your Next Shot as a Physician  by Dr. Greg Bledsoe

The Need for Concierge Medicine  by Dr. Steven Knope

New Concierge Medicine Series: Royal Pains  by Mr. Jeff Barson

Health Matters  by Melinda Beck of the Wall Street Journal

Worldwide Wellness in Outside Go magazine

Total Access: Concierge Medicine Puts a New Spin on Healthcare  in The New Yorker magazine

Are Physicians Pawns in Our Healthcare System?  in AzMedicine magazine

Doctors Switch to 'Concierge' Practices  in Arizona Republic

Books

Concierge Medicine: A New System to Get the Best Healthcare  by Dr. Steven Knope

Podcasts

Dr. Steven Knope: Concierge Medicine  on MedicalSpaMD.com     

Dr. Knope Reveal All  on The Entrepreneurial MD 

Personal Pediatrics Delivers Care Right to Your Bedroom  on  The Entrepreneurial MD 

Organizations

The American Academy of Private Physicians 

Franchise Models

MD VIP

Personal Medicine 

MD2

Dr. Craig Koniver Adds His Voice To Freelance MD

Craig Koniver MD has joined Freelance MD as a contributing physician author.

Dr. Koniver been practicing medicine since 2000 when he graduated from Jefferson Medical College in Philadelphia.

In 2006, Dr. Koniver opened Primary Plus Organic Medicine where he practices Organic Medicine. He started a supplement line formulating different types of nutritional supplements.

Dr. Koniver also created an iPhone App called 42 Healthy Solutions to help patients keep track of their supplement intake as well as provide supplement programs for them to try.

Dr. Koniver also wrote the book, Connect(ed): The New Rules of Medicine, my manifesto for how we can change medicine for the future, for the better.

Freelance MD is excited to have Dr. Konivers cotributions.

Get Your Dopamine Firing

By Craig Koniver, MD

"Elated. Enchanted. Alive."

These are the words that are common to people experiencing a dopamine burst. This is true for those in love as well as those who just deeply connecting to others. What is your dopamine doing these days?

Modern medicine is broken--I don’t need to tell you that. There are too many sick patients and far too many unhappy doctors to think otherwise. We have more heart disease, cancer, diabetes, obesity and depression than ever before. There are more people with autoimmune disease than cancer and heart disease combined. On top of that patients are not happy with their doctors and they are taking these frustrations out on us and our staff.

On the flip side, we too, as doctors are also struggling. The role of the private practice is being destroyed as doctors leave their office settings to work for hospital systems or larger corporations. Many, many of us are dissatisfied with all of the administrative, insurance and government bureaucracy that causes us to wonder what medicine really means anymore. Malpractice premiums are rising at the same time that insurance reimbursements are falling and diminishing. This is why you come to this website, right?

On both sides of the coin, we now have a scenario where our beloved medicine has changed for the worse and both ourselves and our patients are struggling to know what to do next. Throw in the uncertainties related to Obamacare and our anxieties and frustrations are compounded.

It is not hard to trace the roots of the medical system demise--it certainly parallels what has happened with our economy and society over the last century. The industrial mindset has dominated our economy, our school systems, our political systems and our medical system as well. Many of us grew up believing in this system--go to school (obey the rules), get a degree (obey the rules) and then get a job (obey the rules). This industrial mindset that allowed for the factories to make the rules for the workers is exactly what happened in medicine where the doctors set the rules for patients.

Patients wanted this because this is the system that we all believed in. In medicine, this system flourished once antibiotics became a valuable commodity. Now instead of the patient and doctor working together to help heal the patient, the pharmaceutical drug became the holy grail. Doctors became masters of these drugs and the pharmaceutical industry blossomed beyond belief. Of course it was not limited to just antibiotics--soon after, we had hormones and antidepressants and antipsychotics and blood pressure medicine and cholesterol medicine!

We are focused on the wrong product! We as doctors have not spent nearly enough time and energy developing connections to those around us. This includes our patients, but more importantly includes our family, friends and colleagues. We did this to ourselves. Unhappy with medicine? This is what we get when we focus our attention on the wrong product.

What we need to do now is take a step back and pause. Because what truly matters in life is how quickly and how deeply we can form connections with others. That is the product worth focusing on--our relationships.

If you truly want to bring about more satisfaction in your life outside of medicine, than you have to be willing to approach life differently. Simply put, we have been trying to acquire the wrong “things”....sure, money, status, toys are all worth the while, but nothing compares to acquiring real interactions with the people around you.

Did you know that when you form a deep connection with someone the Dopamine in your brain fires as if you were on drugs? Literally. Problem is, we have been trying to get our dopamine fired up from all of these material pursuits in life. No wonder we get bored and disinterested in modern medicine. All that system cares about is managing patients with more meds.

Sure, modern technology is to be embraced and there certainly is a time and place for pharmaceuticals--there can be no denying how great an impact they have made. But to continually blame others (insurance companies, government regulations, patient non-compliance) for the current state of our much maligned system without taking responsibility ourselves is a huge mistake.

We are as much to blame as everyone else involved. We all understand that medicine is not going in the direction we all want, but I feel that we are missing the larger and broader points. Medicine, both in and out of the office, needs a new set of rules for us to follow. We have to start focusing on our relationships in our lives above all else. Outside of the office, we have to be ready to put down our iPhones and listen to our spouses and our children. We have to be willing to start digging in the mud and stop shooting for the stars. In the office, we have to stop relying on drugs and surgeries to define what we do.

Because ultimately our patients and ourselves want the same thing. We want to feel a connection, to have an interaction with our patients and those around us. To view this in any other way is counter-productive.

To help facilitate yourself forming deeper and faster connections with those around you, try the following few, simple ideas: --Use positive words to help set the table for your interactions....remember, people use the same positive words to describe how they feel when they are feeling great

• Mirror the behavior of those you interact with: people seem to be able to reach a deeper level of connection when they talk with those that can mirror how they talk (some people like to talk with their hands and some people like to sit perfectly still when they talk)
• Use body language to your advantage: a small touch on the hand or elbow can go a long way in helping establish deeper levels of connections
• Look into the left eye of the person you are interacting with: the left eye is the receiving eye, while the right eye is the deflecting eye

The sooner you are willing to step up to the plate and start connecting to the people in your world around you, the better you will feel and the more successful you will become. Your dopamine will thank you for it, I guarantee it.

About: Craig Koniver, MD runs a busy Organic Medicine practice in Charleston, SC. He writes at http://organicmedicinenow.com

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