I just returned from the sun-drenched Rockies where the 2009 Aspen Health Forum, hosted by the Aspen Institute and TIME magazine was held. The clarity of mind induced by the fresh mountain air (or perhaps the neutral venue and balanced conversations) crystallized my vision for meaningful health care reform, which I shared with TIME magazine managing editor Rick Stengel as we answered questions from the his readers about "The Doctor Oz Show" and what role it might play in the larger framework of health in America.
Part of the challenge we face is that all eyes are focused on health care finance arguments in Washington, but the real action is taking place in our homes across this great land. We cannot have a wealthy country without being a healthy country, but health care finance solutions by themselves do not help us care for our health. An insurance card is correlated with, but does not guarantee a clean bill of health.
I am a practicing heart surgeon, but I also attended Wharton Business School and have joined Oprah Winfrey on TV and radio, so I have collected many insights from wise souls knowledgeable about this nation's battle for health.
My prescription for health starts with the fundamental reality that no health care finance solution will work without arresting the increasing costs of the health care business. I know this is painful news for many, but doctors are used to giving bad news and still maintaining the respect of our patients, so please keep reading.
To control costs without rationing care, we need to improve the quality of the services we buy for our money. Economists and the few remaining car salesmen would agree that this translates to better value. We have two principal options. First, we need to eliminate the 20% of services offered that are wasteful or harmful. For example, if you live in Texas, California, and Florida, your states offer some of the most expensive health care in the U.S. without providing measurable benefits. Their health care offers limited value primarily because some in the medical community lost their way. Many in my field have lost the art of listening - spending time with their patients so that they can address the true issues rather than offer quick-fix patches on the immediate problem at hand. Tests and complicated (not to mention, expensive) procedures are ordered all the time, but without a full and comprehensive understanding of a patients' needs. After all, it's more cost-effective - and better medicine - if we can make meaningful diet recommendations to patients rather than put them on diabetes medication for the rest of their lives. If we want true reform amongst our own ranks, we must move from a state of reactive use of technology and testing into a more proactive state of dialogue.
Doctors need to act like professionals and police our own for doing unnecessary tests and procedures but we also need smart patients to insist on second opinions that will change their diagnosis or therapy in a third of all cases. You heard right. Over 30% of patients will get materially different recommendations from a second opinion. Many of you are bashful about pushing to see another doctor, but when you get doctors to speak with each other about your case, they teach each other and every subsequent patient that sees your doctor will benefit because you were brave enough to drive quality into the system.
The second major improvement requires revisiting the business model of medicine. Professor Christensen of Harvard Business School taught me on a show recently that two primary models exist for any business (excluding networking businesses). "Solution shops" offer intuitive insights into unpredictable ailments, something doctors (and lawyers) are superb at addressing. On the other hand, value-adding processes like building cars in an assembly line or managing correctly diagnosed diabetes with a specific plan for chronic management are far less expensive than solution shops and usually are more effective in offering reproducible results. In America, we lump these fundamentally different approaches together so we get highly trained doctors using sophisticated approaches to manage tasks that could often be better accomplished by other well-trained health professionals who actually like double-checking that you took your medications and watched your diet.
We speak of prevention a lot these days, but what does prevention mean? I moderated the last White House Town Hall on Health and came away from the experience understanding that America believes "prevention" is really about making the right thing easy to do. This includes everything from making healthy locally grown vegetables easy to find, bike racks available in our work places, and a health care system that provides a crutch to remind us that we forgot our colonoscopy. We cannot look to Washington for these changes without engaging the battle ourselves. I am transitioning from being a full-time doc to hosting "The Doctor Oz Show" because of a civic responsibility that all professionals have to speak out on issues that affect our communities. We are the ballast that steadies the ship of society heading into the troubled waters of health care reform. I am moving from an operating theatre to a television studio to affect this change, but we will only succeed if a willing audience of activist citizens follows and serves their fellow man by making the right health decisions easier to make.
"The Dr. Oz Show" premieres Monday, September 14 (check local listings).
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