Monday, October 22, 2012

Digital Health and Expectations

A story about health care and it’s pitfalls.

Medical students and naivette seem to go together.  Attaining the somewhat envied position as a medical school acceptee most students are not well grounded in the tribulations and expectations that they will be serfs and servants to those one year ahead of them in the long ladder to licensure.  We gird  our loins at each step fully expecting things will lighten up as we approach doctor-hood.

We manage our lives, our finances, our spiritual life, however for emotional well-being we need to manage expectations.


A popular blogger and social media expert, Seth Godin, writes in his blog, Seth Godin’s Blog

“From the stock market to tech to what's under the Christmas tree, we let expectations determine whether or not something good has happened. Not whether it was useful or kind or productive or delightful, but whether it beat our fantasies.

There are two things you can do with this truth:

1. Spend a lot more effort managing expectations, and

2. Focus on the wonderful instead of the exceeded.”

Seth blogs, and pontificates in several basic lessons (books) for marketing. Eventually most MD’s realize that on some level they are “salesmen”, either in convincing a patient they need a procedure or to gain more patients for their practice.   During our years of training this skill is largely not encouraged (for obvious reasons). We are to remain objective, and imperturbable.  MDs by and large do not endure self-aggrandizement well, we are reticent to describe how we are so wonderful, or the best, unless we hire or someone voluntarily want to magnify our image.


Health care is in a state of confusion, in some ways a contest between modernity and meidevilasm, the old way and the new way.  We are confounded with operating our medical organization, large or small in a bifurcated  paradim, on one side fee for service and the other with accountable care, unleashed from procedural billing.  The pressure increases to maintain financial viability, and at the same time maximize quality, decrease untoward outcomes as measured by arbitrary standards by outside forces, such as readmission rates to a hospital.

Cycle worse, cycle better

The downward spiral is all too familiar. A drinking problem leads to a job lost, which leads to more drinking. Poor customer service leads customers to choose other vendors, which of course leads to less investment in customer service, which continues the problem.

Your boss has a temper tantrum because he's stressed about his leadership abilities. The tantrum undermines his relationship with his peers, which of course makes him more stressed and he becomes more likely to have another tantrum. An employee is disheartened because of negative feedback from a boss, which leads to less effort, which of course leads


Most things that go wrong, go wrong slowly.

The answer isn't to look for the swift and certain solution to the long-term problem. The solution is to replace the down cycle with the up cycle.

This is incredibly difficult. But identifying the down cycle and investing in replacing it with the up cycle is the one and only best strategy. The alternative, which is to rationalize and defend the cycle as a law of nature or permanent habit, is tragic.  Much of this includes our attitude of where we are in health care.  Are we stuck in a cycle of renewal?

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