So Dr. Richard Baron’s What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice shows up in the Occasional Notes section of the New England Journal of Medicine on 4/27/10, and the watchful editors at the New York Times and USA Today are already busily turning it into News Of More Than Occasional Note.
And rightly so.
So what’s being said?
The NY Times’ Steve Lohr, a health journalist who “gets it”, doesn’t seem to get this one – at least not in his opening lines:
A new study detailing the uncompensated work burden on family doctors points to the need to change how they are paid, medical experts say — particularly as the new health care law promises to add millions more patients to the system.
Really Steve? The thrust of the piece is that doctors need to be paid differently? Or is it rather that they have to practice differently, so there is justification for paying them differently?
You can probably guess what we think, but here’s a passage directly from Dr. Baron’s post that bolsters our confidence in thinking so (with our emphasis):
The work we describe arises from the needs of patients in a society that assigns many roles to physicians — from making diagnoses and providing treatment to ordering tests and filling out forms — and the practice must be organized to respond reliably. How and by whom the work is done is a continuing project of primary care redesign, dependent on both the skills of available nonphysician staff and the extent of information-technology support.
Meanwhile, correspondent Lohr only gets to this concept indirectly, at the very end of his brief report, and then thanks to a quote from Obama administration HIT point man Dr. David Blumenthal (again, we’ve provided the emphasis):
….Dr. Blumenthal said the study showed “the enormous strain” on family doctors, but also “a pathway toward escaping at least some of those burdens: the electronic health record combined with changes in workflow and payment.”
USA Today’s Rita Rubin gives greater emphasis to the “what are primary care doctors actually doing?” aspect of the story – taking it less for granted that what primary care doctors are doing is what everyone thinks they’re doing, and what they ought to be doing – but she still does not delve into the trickier, thornier, more sensitive matter: what if, once what’s going on there is fully sorted out, everyone discovers that other health care practitioners are better situated to do some of those things, in league with a “re-purposed” contemporary primary care physician?
Now there you would have a platform for disruptive innovation.
EXTRA CREDIT: It may seem unrelated at first, but we feel The Data-Driven Life (New York Times, 4/26/10) supplies valuable commentary on the vital issue of applying data to the information-driven business of deciding “what am I doing, is it what I fully intend to be doing, and what might I do differently to do what I intend to do better?”Tweet