In an era of corporatized healthcare, in which many physicians clamor to lead, there are but a few true leaders. Dr. Sachin H. Jain is one of those few. So when he writes, we read.
In the early days of summer he penned a piece advocating for a Civil Rights style movement in healthcare.
He called for the tent poles of healthcare to be replaced, touted income inequality as healthcare inequity, and criticized healthcare’s propensity towards aggressive, expensive treatments in favor of preventative care services.
He concluded with a series of platitudes calling for more common sense, employer health reform, and healthcare equality before ending with a plea for action – “find fundamental solutions”.
But to find fundamental solutions, we require fundamental thinking, or as Aristotle coined it, first principles thinking. We need to address the root causes that create the problems we all want to fix in healthcare.
This calls for a more abstract thinking, focusing less on healthcare disparities or inefficiencies in the healthcare systems, and more on the perceptions and beliefs that give rise to the disparities and inefficiencies in the first place.
“We cannot solve our problems with the same thinking we used when we created them”, said Albert Einstein. But to introduce new thinking into healthcare, as Dr. Jain said, we need more courage and imagination.
Two attributes in short supply in healthcare today.
Healthcare is mired in regulatory red tape, to where the regulations define healthcare itself. Herein lies the problem – and the solution.
To encourage fundamental solutions in healthcare, we must reduce the cost of errors and enable innovation. Healthcare has become risk adverse because the penalty for a mistake has become exceeding high.
We once touted evidence based medicine for the standards and protocols it offered healthcare. But those same data points and guidelines have now confined healthcare to the rubric of standardization.
Data has codified into law, and the art of medicine has transformed into the industry of healthcare liability.
In such an environment there is no room for courage and imagination. Instead we find risk adverse physicians-turned-consultants spewing jargon from the latest best-selling book.
If we truly want change in healthcare, then we must not only change the way we think, but make it easier to think differently.
The most powerful way to think differently in healthcare is through first principles thinking. Through such thinking we understand why diabetics remain noncompliant – despite the many anti-hyperglycemic medications and insulin formularies, and novel sensors that measure blood glucose in real time.
It is not the effectiveness of the treatment, but the perception of the treatment that matters to the patient – and what matters to patients is what matters in healthcare ultimately.
A principle we have lost in modern healthcare. By hiding behind the litigious veneer of modern healthcare, physicians have been disconnected from their patients.
We now need clinical studies to educate physicians on communication strategies for patients who are vaccine hesitant. We have the best healthcare technology, an efficient vaccine development and distribution system, yet we have only 51% of the population vaccinated – nearly nine months after the vaccine became available to the public.
This is not a disparity problem, nor an efficiency problem – it is a fundamental problem of thinking. Physicians and patients think about vaccine effectiveness and safety differently, yet neither understands that the other thinks differently, creating a conceptual divide between physicians and the patients they serve.
A divide that arose as physicians trained and practiced within a world of healthcare that rewarded certain ways of thinking and punished other ways. As a result, courage and imagination wither in favor of conformity and compliance.
In such a world, a call for physician advocacy in the vein of the Civil Rights movement risks becoming another hollow catchphrase to be coined among the physician-consulting class.
But if we are to remain true to Dr. Jain’s words, advocating for meaningful change in healthcare, then we need to first change how we think – and begin thinking in first principles.
Per capita national health expenditures from 1960-2020
The data categorizes expenditures as national health expenditures, health consumption costs, personal health costs, administrative costs, and public health activities cost.
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census.