Archive for Culture

How technology affects the physician-patient relationship

A couple of recent readings tie nicely together. In the latest issue of The Hastings Center Report, Naalla Schreiber tells of a hospital stay during which her complaints were not easily attributable to any obvious medical problem. Her physicians used the code words “functional syndrome” to describe her problems, and she described her treatment as less than pleasant. Until of course, tests finally provided a medical diagnosis, confirming what she had suspected all along. In the meantime, she became what many physicians would regard as a difficult patient. It’s not like Schreiber is new to the medical profession either: she is a practicing psychiatrist. Her analysis of the situation puts some of the blame on technology:

“As medicine becomes more technology-oriented, less time and emphasis are placed on learning and practicing the art of the doctor-patient relationship. Patients, are viewed as the sum of their diseases, rather than as unique individuals with physical, emotional, and spiritual needs that impact their health.” 

Well said, and here’s to improved communications!

The independent practitioner is also being hit from all angles, one of which is the drive toward more technology. The New York Times relates the story of a physician whose business is threatened by lower reimbursement and the need to see more patients in order to continue as a viable business. His patients like the extra time and personal attention he enjoys providing them, but he cannot do both. The physician’s son explains that his father’s business model “is going to be extinct very soon,” and notes that the amount of time and money needed to employ an EHR system would be another blow to his ability to keep the business going. Fewer and fewer physicians are self-employed, as more join large groups and specialize.

Is there a balance then? Must the “personal touch” and technology be mutually exclusive? Is there a way medicine can become more technology oriented while maintaining respect for the human component? Does it matter? Each patient has a narrative, and so does the medical profession. How will that narrative read in another ten years?


– Rod Piechowski

© 2011 The Art of Medicine and Technology

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Reform is Technology Dependent

Information technology is scattered widely throughout the health reform bill that was passed in the US. In order to accomplish many of the goals stated in the bill, information technology will be increasingly investigated as one component that might offer a degree of savings or capability to the system. Whether we are talking about checking for a patient’s insurance eligibility, medical homes or improving patient access to information, technology is at the heart of the solution. And it isn’t really just technology that will be responsible for this change: what we’re really talking about is information management, using technology as a modernized means of collecting, storing and moving information throughout the system. » Continue reading “Reform is Technology Dependent”

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Building a Great Team V

So far we’ve discussed four of the elements I like to look for when building a team that will be required to drive massive changes in the way things are done. Transforming a healthcare practice or hospital from paper-based information to a paperless environment certainly qualifies as a massive change. Previously, I’ve outlined curiosity, creativity, confidence and compassion. The fifth thing I look for is competence.

I assume that by the time we’re talking to people about working together, that is, we’ve gone beyond the resume stage and are into the interviews, potential hires must have demonstrated some degree of professional or technical competence in order to get this far. I consider competence then, in the context of whether or not somebody has, in aggregate, the qualities previously mentioned, and whether or not that “package” is suitable not only for the long-term mission of the organization, but for the more immediate task of transformation.

Without these five components, you increase the risk to both the organization and the individual. When building a team that will see you through a complete organizational change, neither the organization nor the individual (if you do this right) will resemble the original at the end of the project. We’re not looking to fit someone into the current process, because that process is due to change. We’re looking for people who can, as previously noted, thrive within ambiguous territory. This is especially true for executive leadership. People get used to having information and answers to questions, and that’s one way we demonstrate our historical competence. When everything changes, immediate and solid answers may only come after time and with more experience.

These qualities of individuals scale up to the organization as well. If your organization is prepared for systemic change, curiosity, creativity, confidence and compassion will enable an environment where fluidity of change increases the overall competence of the organization. This in turn, contributes to the ability to visibly participate in a leadership role in the community of those who not only provide healthcare, but who actively push forward, defining the future of healthcare delivery.

Your thoughts and comments are welcomed!

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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Building a Great Team IV

It’s hard to imagine that anyone could work in the healthcare field without having some degree of compassion for others. Yet, the reality of business, and continued pressure to do more with less for less, could no doubt squeeze the last bit of feeling from almost anyone. For our purposes though, I want to look at compassion as a component that complements the rest of the five traits I look for when building a team that must lead through systemic change. This trait:

  • Reduces the prevalence of “me first” in the workplace because people more clearly see the positions of others, and can more easily integrate other points of view into the re-engineering project;
  • Is likely to be found in people who consider the patient as the ultimate beneficiary of positive change through technical innovation, and they are less likely to toss aside “the patient comes first” as a tired slogan;
  • Should be a thread that runs throughout the fabric of an organization’s culture. Remember, it is culture that must really change in order to successfully convert from paper-based to paperless information exchange. Technology is just the tool;
  • Is especially desirable on a team when the status quo is broken, methods are in flux, and there is ambiguity in roles;
  • Builds trust;

Next, I will tie all of these traits together and discuss competence.

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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