Archive for July, 2008

The Patient-Physician Relationship

Tuesday, July 29th, 2008

It was one of the big healthcare stories in today’s New York Times.  It started out by saying:

      “A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.  The relationship is the cornerstone of the medical system — nobody can be helped if doctors and patients aren’t getting along. But increasingly, research and anecdotal reports suggest that many patients don’t trust doctors.”

Right there in the opening sentence, written between the lines, is the crux of the problem.  The author like so many of us put the “doctor” first in the “doctor-patient relationship”.  It’s a subtle but important distinction.  It is essential that the public and those of us in the medical profession learn to appreciate this distinction.  If there were no patients there would be no need for physicians.  Ergo it is the patient that comes first in this relationship.  The patient’s healthcare needs are what created the physician’s healthcare solutions.  Like I said it is a subtle distinction to reverse the order but it says so much about how we view the world of healthcare services.

While I am on this topic you may have noticed a couple of other related observations.  One is that I specifically did not refer to the “patient-doctor relationship”.  In the United States the conventional use of “doctor‘  refers to a medical doctor.  This is not always the case and “physician” or “medical doctor” is the more appropriate term.  Another point is that recently the “patient-physician relationship” is quickly being replaced by the “patient-provider relationship”.  I’ve discussed some of the reasons for this in a previous blog.  Suffice it to say I believe it is because the “cornerstone of the medical system” is changing.  I suspect this is really the reason the trust is breaking down.  The real question is if patients don’t trust doctors who will they come to trust?

The Knowledge Worker & the Cost of Healthcare and Education

Monday, July 28th, 2008

The knowledge worker is an expression first described by Peter Drucker in 1959.  Over the last fifty years the knowledge worker has become the most essential and fastest growing member of the workforce.  It can be argued the knowledge worker has always been the most essential member of any workforce but in the information age they have taken on new value due to their vast numbers.  What is interesting is not only the growth in numbers of knowledge workers but also the cost of maintaining this booming generation.

Each age places an extraordinary amount of value on that which most contributes to output.  When we were primarily an agricultural economy value was placed on the land and the means to grow, harvest and bring to market the crops it could produce.  During the industrial age a factory’s plant, property and equipment were the primary assets of value.  In both ages the owners of the land or factory invested a relatively large amount of resources to insure the most efficient use of the assets that were the drivers of production and the creators of wealth.

The times are changing and it is the knowledge worker that has become the primary asset that creates future wealth.  Due to the growth of this member of the workforce is it any wonder that the value we place on health and education has increased?  Education is the way we maintain and upgrade the intellectual capital of the knowledge worker.  Healthcare is not only a way to repair and heal the knowledge worker during the down-time of injury and illness it is a way to maintain the long-term operational effectiveness and efficiency of this valuable workforce.  When we look back on the rapidly rising cost of our healthcare system we may find that one of the primary reasons for doing so was to preserve and protect the knowledge worker and the value they bring to our society and our economy.