Doctors have gripes galore about the third parties looming large at the bedside and in the examining rooms who effectively drive care by setting fees, dictating benefits, even making medical decisions such as whether a patient can have an extra hospital day or be allowed an MRI. It's legitimate for payers to question expenses, but it's also hard for the solo practitioner to stand up and be heard in this environment.
That brings us squarely to the question: What is replacing our romantic notion of the solitary, autonomous doctor? Ideally, one would hope for an integrated team working together on behalf of common medical goals, with the patient at the center. This, as opposed to what so often happens today: a loosely allied group of independent, unrelated practitioners drawn together in a defensive huddle to meet the needs of insurance contracting and managed care.
The integrated team model has been around a long time, but it is still the exception in today's private medical practice. It was pioneered by the Mayo Clinic more than 80 years ago. The architect was the surgeon W. W. Mayo, who was fond of saying, "No man is big enough to be independent of others." Mayo and his two surgeon sons, Will and Charlie, developed a model of "cooperative individualism," in which top-notch physicians from all disciplines were carefully selected to work together in salaried positions. Salary was key, because it meant the docs were not answerable to accountants for their medical decisions, and it was understood upfront that some of their fees would be plowed back into the institution. Many in the medical field saw such a cooperative venture as downgrading the medical profession, by making doctors cogs in a wheel. Ironically, the problem today is that all too many individual practitioners see themselves as little more than cogs--but in a broken wheel.
Sidelines. The clinic model, or some variation of an integrated team, is just what medicine needs today. It will work, however, only if it comes with the purpose and the faith that this will bring better care of the patient and enable the squeezed practitioners to remember what brought them to medicine in the first place. Indeed, the 21st century finds physicians and their patients struggling to meet the medical and economic demands that necessitate team-oriented healthcare. Here we might learn a thing or two from America's most favorite spectator sport, football, and one of football's best, Coach Bill Belichick of the New England Patriots.
Belichick astounds the sports world by his ability to build a Super Bowl-winning team of solid but not splendiferous players. His strategy seems simple: Accentuate any given player's strength, and manage around the weaknesses, something you can do if you have a versatile team. He is proud of his team for being made up of unselfish guys, who work hard, respect him and one another, and on the field are committed only to winning. A group of comparable or even higher-quality athletes, unable to consistently work in unison, would be self-defeating.
That is a lesson for the kind of teamwork that is essential in the medical field now and as we look ahead. It comes with benefits, including pride in doing better for patients, intellectual stimulation, fewer administrative hassles from the third parties, and more reasonable work hours. And, as in football, a successful medical team's glue is that intangible called faith--in one another and those they serve. That timeless ethos is captured in words penned by the Cleveland Clinic's late surgeon George Crile Jr. in 1955:"No physician, sleepless and worried about a patient, can return to the hospital in the midnight hours without feeling the importance of his faith. The dim corridor is silent; the doors are closed. At the end of the corridor in the glow of the desk lamp, the nurse watches over those who sleep or lie lonely and wait behind closed doors. No physician entering the hospital in these quiet hours can help feeling that the medical institution of which he is part is in essence religious, that it is built on trust. No physician can fail to be proud that he is part of his patient's faith."