Opinion: Value-based care starts at the bedside

As an immigrant child from a war-torn country, I would not choose medicine to promote social justice. While studying in medical college, I realized that medicine can change the course of pathologies that are inherited, at least in part, due to socio-economic factors, and as a doctor, I can correct the mistake.

When I began my clinical rotation in New York, I quickly realized how different the study of medicine was from the practice of medicine. In one of the busiest hospitals in the country with no electronic health record, I learned that continuity of care is an uphill battle. Overcrowded and understaffed, we were a pipeline for patients receiving the equivalent of patches for acute manifestations of deeper and more complex medical problems. .

This led me to look for a smaller, slower paced city where I could be more critical of my patients’ pathophysiology to correct what was wrong. In residency, I experienced the transition from “medicine” to “health care.” But I couldn’t just take care of my patient, I had to take care of his medical record and prioritize for fear of missing out. Meanwhile, the patient tried to tell me everything I needed to know, but it didn’t matter because it wasn’t documented, wasn’t timestamped, and couldn’t be found. In addition, “medical necessity” often meant that patients could not receive care in the hospital that could be provided on an outpatient basis, although there was no mechanism to ensure that this would happen after discharge.

At the end of my training, I still didn’t feel like an effective doctor. Because hospitals were meant for occasional care. To ensure the continuity of care I craved to better manage patients, I took my first job as an outpatient doctor in an underserved community. I soon realized that although I had more time with my patients, I didn’t have the resources to give them the care they needed. I didn’t know how to help a patient who couldn’t afford a life-saving blood thinner for more than $500 a month, or a patient who didn’t have transportation to get to their destination.

After six years of satisfying my intellectual curiosity, but never truly satisfying my need to help patients, I realized that I was suffering from medical burnout. But I couldn’t shake the feeling that it wasn’t a burnout, because that means I wanted to step back and do less, but I wanted to do more – a lot more. What I was suffering from was mental trauma because I knew what my patients needed but didn’t have the training to fit it into the business structure, the resources to do it, or the incentives to support it. So I eventually found my way to what seemed like the beginning of a solution to this phenomenon: value-based care, which I like to think of as patient-centered care.

Today, the US spends over $4 trillion on health care with over 900,000 healthcare companies, over 6,000 hospitals, 500 accountable healthcare organizations, and close to 1,000 health plans, yet still lags behind in results compared to other developed countries. I am part of this ecosystem, but I constantly ask myself: how involved are our providers? And I’m not talking about vendors like me who have gone out of the game, albeit in an attempt to create a better playing field for others, but those who defend the front line, waiting for a better system driven by a goal far greater than their own. own interest. It got me back in bed as I continue this journey to be the change I hope to see in the world.

I recently saw my first patient after two years and felt like picking up where I left off. This patient was the same person I met on my first visit to a hospital in a busy downtown medical center. The difference was that I had changed. Although I didn’t know how to address all of her needs at once, I knew where to find solutions. Moreover, I knew that solutions existed.

As service providers shift their focus from the health sciences to the gaps in healthcare delivery, it will take a village of business and academic leaders, technology decision makers, payers and policy makers to succeed. Although value-based care decisions are far from perfect, they are the first step towards realizing the need for change. As we embark on a journey to design the health care system of the future, I encourage my fellow physicians to overcome past feelings of frustration and hopelessness to move forward and lead the village because, ultimately, change begins at the bedside.

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