Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to adjust their focus. They resist systemic innovation. Because they cannot flip, they flop.
This habit — resisting change, staying focused on the trees, instead of the forest — means that significant system evolution often occurs without physician voices, simply because doctors refuse to be involved. This results in error, inefficiency and lost opportunity. Paradoxically, when flawed change is forced on the medical system, it burns out doctors. Thus, instead of working as a team, involving themselves from the start in building and growing, physicians become victims of change, reduced to painful irrelevance. Therefore, the failure to build functional health care and the miserable state of many health systems is, to great extent, because of the self-imposed isolation of physicians.
A couple common examples will suffice. Doctors have fought, tooth and nail, against the precertification process of health insurers. They battle against the payers with the indignant anger of neglected children. However, insurers have been forced into an intrusive system of obstructive payment, because doctors refuse to mind their own shop. Physicians insist on ordering what they want, regardless of cost or net patient benefit. Doctors do not watch the henhouse, so someone else has to. It would have been a very different world if, from the start, the medical profession had accepted financial stewardship as part of their mission.
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