Good advice is the hardest quantity to come by. Fortunately for doctors, many of the hard-won lessons from the business world translate directly into the practice of medicine.
Good advice is the hardest quantity to come by, more than information. In the Garden of Eden, the low hanging fruit was knowledge; the unmentioned treasure hanging on the higher branches was wisdom. Instead of climbing the shaky ladder to the top of the tree on our own, let’s take advantage of those who have preceded us in their quest.
Jack Weymer, a financial advisor, has ruefully admitted what most advisors are in denial about; ”Contrary to conventional wisdom, the biggest risk that investors face isn’t the volatility of the stock market, it’s bad financial advice from expert advisors.” Unfortunately, as most of us have learned, the same can be said too often for medical expertise. Caveat Emptor, let the buyer beware, still reigns supreme in all human dealings.
Another insight comes from a fellow named Becher who avers that “Businesses tend to measure the wrong things. They dwell on activity metrics, which are easy to collect, as opposed to outcome metrics, which monitor impact.” This is another parallel to medicine which has been bedeviled with efforts to make the same shift, and in so doing, establish a reliable measure of physician/medical “quality.” This goal still eludes our best efforts.
Worth magazine wrote that “…if you want to be a good client in business, to get your money’s worth, you should be willing to be challenged to take action to implement the expensive recommendation(s) given us. “A sadly high percentage of adverse outcomes in medicine are exactly due to the fact that too few patients are good at following advice. Non-and-poor compliance is the bane of our profession and our constant attempts to get the best results.
Another bit of business wisdom that directly translates to improving patient compliance is the Disney Company precept that “…good service creates an emotional rather than a purely rational connection.” It is confounding that little in medical training or literature focuses on this key human attribute. We often lose the forest for the trees; we sometimes forget that we treat people, not just disease and injury. And better service translates directly to the bottom line, as well as improved compliance and medical outcomes.
The American economy, the American Way, devolves upon price transparency. We advertise, we shop, we compare. The fact that healthcare has opaque pricing costs the economy at least $36 billion per year, according to a Thomson Reuters study. The usual medical rationalization is that you can’t compare apples with oranges, that every patient is different. Yes, but it’s sometimes ingenuous to say so. To explain away fee-for-service excess by blaming it all on patient variation is too often lazy, inefficient, and expensive and such glib evasions of accountability just makes what we do even harder, both medically and financially.
Lest we overlook the huge—and growing—bureaucracy that is a left-handed attempt to work around the flaws built into our healthcare “system,” consider the observation by a writer named Hayek that “…bureaucracies attract people who enjoy running the lives of others…and they find that power increasingly attractive.” A well-run business or healthcare organization, big or small, needs less bureaucracy and can save big money by reducing it. As well as keeping these sorts of folks out of our lives and marginalized where they can do less mischief.
Lastly, John D. Rockefeller, the first billionaire, once said, “A friendship founded on business is better than a business founded upon friendship.” Seconded by Andy Grove, who founded Intel on his way to becoming a billionaire, who built on Rockefeller’s perspective with, “It’s fine to hire your friends as long as you’re willing to fire them as well.” Those considering joining, or functioning, in a medical group, large or small, could do well to ponder these hard-won opinions. Medical groups can be a tough gig if not structured properly by outside experts. Governance and compensation are always problems #1 and #2 in business, and in medical organizations. Bear in mind that it’s never too late to get professional advice.