Disruption in healthcare is happening (whether we like it or not)

Healthcare, and particularly medicine, are slow-moving beasts. This doesn’t mean that innovation isn’t happening. In fact, it’s happening at an alarming speed and doctors are grappling with a quickly expanding knowledge base.

But the highly regulated, traditional industry is vulnerable to external disruption, and we’re seeing more and more examples:

  • DIY tests like skin cancer apps and pap smears
  • Online script services
  • Skin checks at the pharmacy
  • Vaccination services outside medical practices
  • Medical tourism

The flip side of convenience

Disruption is not necessarily the same as innovation. Disruptive services or products are simpler and more convenient to use, but their quality is often poorer.

In healthcare, the risk of disruption is that it affects health outcomes. It may lead to fragmentation and loss of opportunistic screening. I’ll give two examples:

Example 1:  More providers does not equal better care

A busy family doesn’t have the time to visit the doctor and decides to use convenient online health services. As a result they hardly ever visit their family doctor, and if they do, their doctor does not have the complete picture as more health providers are involved in the care.

Example 2: Convenience does not equal safety

Women doing their own pap smears at home may take incorrect samples. Although avoiding the ‘stirrups’ in the doctor’s office is a big plus, the risk of avoiding an expert examination is that things get missed.

The way forward

Disruption in healthcare is happening, whether we like it or not. “Successful entrepreneurs naturally look at opportunities in terms of the jobs they can do for customers,” say the authors of this article. Although it is unlikely that the doctor can be replaced by technology, certain aspects of the healthcare process can.

I believe there are 3 ways the healthcare industry should respond to external disruption:

  1. Continue to listen to health consumers
  2. Develop our own disruption processes
  3. Communicate the strengths and qualities of our services

Marcus Tan, GP and CEO of HealthEngine said in Australian Doctor magazine: “GPs are ideally suited to lead this cultural shift. GPs are highly skilled in managing risk and uncertainty, and are well equipped to make the leaps required to innovate.”

Indeed, if we don’t do it ourselves, others will.

Tribalism, the real enemy in healthcare

Five doctors went duck hunting one day. Included in the group were a general practitioner, a paediatrician, a psychiatrist, a surgeon and a pathologist.

After a time, a bird came winging overhead. The first to react was the GP who raised his shotgun, but then hesitated. “I’m not quite sure it’s a duck,” he said, “I think that I will have to get a second opinion.” And of course by that time, the bird was long gone.

Another bird appeared in the sky thereafter. This time, the paediatrician drew a bead on it. He too, however, was unsure if it was really a duck in his sights and besides, it might have babies. “I’ll have to do some more investigations,” he muttered, as the creature made good its escape.

Next to spy a bird flying was the sharp-eyed psychiatrist. Shotgun shouldered, he was more certain of his intended prey’s identity. “Now, I know it’s a duck, but does it know it’s a duck?” The fortunate bird disappeared while the fellow wrestled with this dilemma.

Finally, a fourth fowl sped past and this time the surgeon’s weapon pointed skywards. BOOM!!

The surgeon lowered his smoking gun and turned nonchalantly to the pathologist beside him and said: “Go see if that was a duck, will you?”

Source: Nursing Fun

What’s great about this joke is not just the stereotype behaviour of the five doctors – which most people working in healthcare immediately will recognise. What is wonderful here, is the different disciplines doing some team building. They may not be very efficient as a team yet, and they could have picked a different activity, but at least they have found a common goal: hunting.

In the real world of medicine we sometimes seem to have forgotten our purpose. The inconvenient truth is that we’re often acting as a dysfunctional team where every member’s main goal is to finish their own little task, and where other team members and disciplines are sometimes regarded as ‘the enemy’.

A while back I was privileged to hear Dr Victoria Brazil speak at a conference of the Royal Australian College of General Practitioners in Brisbane. Dr Brazil is an emergency physician and passionate about the topic of medical tribalism. Instead of the more primitive tribal behaviour – characterised by hostility towards other tribes and the unwillingness to take responsibility for a bigger cause – we should move to a kinder tribalism driven by mission and purpose, without common enemies, she argues.

Dr Brazil reminds us that we cannot achieve the best patient outcome without other disciplines. Building relationships, communicating and networking are the key to success. This sounds obvious but it’s not very often that we make time to sit down and have a yarn with members of other teams.

You don’t have to go duck hunting together, but next time you talk to someone belonging to a different tribe, maybe just introduce yourself and ask how they’re going.

If you would like to know more about this fascinating topic: In the video below Dr Brazil, who is also a gifted speaker, addresses a room full of medical tribes (but with a common interest in emergency medicine). She explains how we can overcome the dark side of medical tribalism. Enjoy.

How to get doctors to use eHealth

How to get doctors to use eHealth

Although doctors are in the top three of most trusted professions, they also have a conservative image.There is the perception that doctors are resistant to change, such as the introduction of eHealth in their practices.

Nothing could be further from the truth.

Doctors are used to change. Medicine and healthcare are areas where new developments happen on an almost daily basis.

However, just because something is new, doesn’t mean it’s better. Many doctors have learned this the hard way. That’s why we need to be convinced before we change our current practices. Not with arguments but with evidence.

It’s best to try a new idea out on a small scale. Prove that a product or service has benefits to patients and doctors – but no major disadvantages – and we will consider it.

Doctor do you bulk bill?

Since 1984 Medicare is the health insurance scheme from the Commonwealth Government, providing free treatment in public hospitals and subsidised treatment for other crucial health services such as the care by GP’s.

Medicare has set a list of fees it is willing to pay for medical services. The fees in the Medicare Benefit Schedule are not recommended fees, but merely what Medicare is prepared to contribute to a consultation or operation.

Unfortunately, as the picture below illustrates, the Medicare fees have not kept up with inflation and costs. While the cost of running a GP practice is going up every year (the upper line in the picture), Medicare has only slightly increased their fees over the years (the lower line in the picture).

Bulk billing
The fees doctors charge are set at a level that enables them to look after patients properly. The cost of providing good medical care is rising (the upper line) but the Medicare fees are falling behind (the lower line). That is why you may find your doctor’s practice does not bulk bill as a rule. AWE: average weekly earnings. CPI: consumer price index. Source: Australian Medical Association.

The Government entirely funds public hospitals, but not GP practices. As a result, GP’s who own their practices need to cover the costs of running a business – just like electricians and hairdressers. Costs include for example paying rent, wages of receptionists, nurses and trainee doctors, and medical equipment.

GP’s who follow the Medicare fees are effectively taking a pay cut every year (the shaded area between the upper and lower line in the picture is getting bigger each year). Eventually GP’s would not be able to invest in their businesses, pay their staff and provide good care to their patients. This is the reason many GP’s charge more than the Medicare fees, and why the gap between the doctors’ fee and the rebate you get back from Medicare continues to rise.

Many doctors follow the list of suggested fees by the Australian Medical Association. Unlike the Medicare Benefit Schedule, this list has been updated annually to keep up with inflation and the costs of running a practice.

Bulk billing is where doctors accept the Medicare fee as payment of their services. But as said, these fees are decreasing in real terms each year. Bulk billing has a real risk that quality of care is affected. Asking a doctor to bulk bill has more consequences than people think. For that reason many GP’s are not bulk billing as a rule – although they can make exceptions based on circumstances such as financial hardship.