October 11, 2015

Slowing Down the Practice of Medicine

Last week, I was at a series of meetings in Washington, D.C. talking with members of Congress and their staffs about the recommendations of a coalition of which I am a member called the CEO Health Transformation Community. One of the other members is Dr. Ray Zastrow of Quad Med, a provider of onsite corporate clinics based in Milwaukee.

Dr. Zastrow made a memorable comment many times during the day. He said that Quad Med increased the quality of care, and significantly reduced its cost,by “slowing down the practice of medicine.” He said that Quad Med health care professionals are expected to spend 30 minutes with each patient even if they diagnose the problem in the first five minutes. He said that every visit to the clinic is a “teachable moment,” and the health care professional must take the opportunity to learn more about how the patient is feeling overall.

I thought about his remark in the context of how Pitney Bowes has delivered care at our clinics. While we do not spend as much time with patients as does Quad Med, we share the same philosophy of getting at the root cause of health problems, rather than simply treating the problem at hand.

I recall a problem that I used to have back in the 1980′s and 1990′s virtually every year. At some point I would get a major staphylococcus infection on my cheeks or some other spot on the lower part of my face. I would go to one or more of the outside physicians with whom I used to consult in those days, and would get the recommended antibiotic for the infection, which I assumed was unpreventable and unpredictable.

In the mid 1990′s, when Dr. Jack Mahoney joined Pitney Bowes as our Medical Director, I visited him with the same staph infection problem. Unlike the other physicians who quickly diagnosed the problem and gave me a prescription, he took extra time to find out about my personal hygiene habits, particularly how I shaved. I told him that I was using shaving cream from a jar and a reusable razor blade, and that I did not use after-shave.

He recommended that I switch to disposable razors and shaving cream from an aerosol container. He also recommended that I use after-shave lotion. He told me that he believed that the jar and reusable razor blade were trapping bacteria from my face in the cream and the razor blade, and that I was getting the bacteria back on to my face from the jar and the razor blade. He said that the after-shave would kill whatever bacteria I had.

Once I began to follow his recommendations, my existing infection not only disappeared without the need for an antibiotic, but I never had it recur. Aside from the fact that Dr. Mahoney is a very practical, smart physician, the major difference between his success in curing the infection and preventing it from reoccurring was the extra time he took to learn more about my personal habits. He taught me a great deal about not only staphylococcus infections from shaving cream, but also the need to make sure that germ-containing household implements not be reinserted into jars that others use as well.

What does this mean for health care reform? The main point we made to members of Congress is that any health care system needs to reward health care professionals for doing a great job, not solely for performing medical tasks. Think about the analogy to stock brokerage prior to deregulation in 1976. Before 1976, stock brokers were rewarded by the number of trades they did for clients, not whether they made money for them. Congress recognized that this was bad for clients.

However, we treat doctors, nurses, and hospitals like old-time stockbrokers. We reward them for volume, not for results. We need payment reform that enables doctors and other providers to emulate the way Dr. Zastrow and Dr. Mahoney practice medicine. There are many great physicians who do great things today, but they have to do so in spite of the payment systems within which they operate. We have to align the payment system to the way they should and want to practice.