PHOENIX-With the election of President Barack Obama and with lawmakers in Washington poised to overhaul the health care system, with patients’ faith in their doctors faltering, and with health costs continuing to rise and quality becoming ever more questionable, Gerald B. Healy, MD, took the lectern for his keynote address here as if he were taking the helm of a ship at risk of being capsized by stormy seas.
The immediate past president of the American College of Surgeons told a room packed with his colleagues that there is no doubt but that the world of medicine is at the threshold of great change-and that they can either do their part to make sure it is change for the better, or risk suffering the consequences if they stand by idly.
There are young folks just out of college sitting around Capitol Hill this afternoon talking about cost-benefit issues in health care, said Dr. Healy, Otolaryngologist-in-Chief at Children’s Hospital of Boston and Professor of Otology and Laryngology at Harvard Medical School. So I ask you: Do you want to be involved in this, or do you want to let them do it for you? We need to step up here, folks. For too long, we’ve come to these meetings, we’ve comfortably talked to one another, we’ve shared wonderful ideas about outcomes, and so forth. But we’re not out there playing in the arena of the rest of the health care world being part of the solution. Oh, we can identify the problems quite well, but we don’t have enough time to be part of the solution.
Without the input and effort of those with the expertise-Dr. Healy and his fellow surgeons-the overhaul will not be one that they will like, he told the crowd at the 2009 Annual Meeting of the American Head & Neck Society, conducted as part of the Combined Otolaryngology Spring Meeting.
Guess what? This is your future, especially [that of] the young surgeons in this room, he said. Your future is here. If you don’t want to spend the time doing this, no problem. There are plenty of people who will do it for you-and then watch the crying and screaming that will come forth when we are faced with a system that we failed to help design and yet are forced to work with.
A President’s Perspective
Dr. Healy said his perspectives on health care’s growing problems were sharpened during his year as president of the American College of Surgeons. He took a year off from his practice and visited 31 states and seven foreign countries in 2007 and 2008. His interaction with surgeons and organized patient groups in those places left him thinking about how doctors are vulnerable to criticism from the people they treat. Furthermore, he said, doctors are missing the chance to educate patients about what will happen if government officials design a new system.
I think sometimes we fail to remember that our patients are our greatest allies, he said. When we see them in vulnerable situations, we have an opportunity to reach out to them to deliver the message about what is going to happen to them and their health care. But sometimes we miss the opportunity.
He said he was deeply affected by a six-page, single-spaced letter he had received just days before he left to attend the society’s meeting, from a doctor who had been the chairman of a large surgery department, then became the dean of a medical school, then became president of a leading academic hospital in the United States. But when he found himself a patient, his experience was most unpleasant, Dr. Healy said.
It was a shameful depiction of what has happened to our profession, from not being listened to, to be being disregarded, to not having any input from his doctors, who were too busy to spend the time talking, he said. It left him with an indelible feeling that we have significant challenges to right the ship so that we will not be vulnerable to criticism from our government and from our patients, who say, ‘Well, you folks can’t fix it, so we’re going to fix it for you.’
Teamwork Is Essential
Aside from problems with professionalism, Dr. Healy said, there is also a problem with teamwork.
The future of surgery in this country is around teams, he said. We were not trained to work in this atmosphere, but we must learn to become leaders of these high-performance surgical teams.
He said there is no doubt that America’s $2 trillion-a-year health care system needs to change. As technology, infrastructure, and other costs rise, patient access and preventive care has declined, and errors are going up-a troubling pattern that Dr. Healy called the great paradox.
He also pointed to a clash of values-the medical world becoming more preoccupied with business principles that are at odds with the humanitarian values that lead doctors into the field.
I’m really sick of hearing that health care is a business, Dr. Healy said. The same people that got us in trouble in the business and then in the banking world in America-have you noticed that they’re now talking to the health care industry? The business schools of America are now running courses for doctors to come and learn all the principles that they taught the people who ran General Motors, Chrysler, Bank of America. Now that those people are gone, they’re looking to you. Be very careful! This is very seductive. It’s about money, it’s about profit, it’s about competition. Does this sound like, perhaps, your hospital?
He said he has watched with angst as business interests have seeped onto hospital boards.
Sometimes we fail to remember that our patients are our greatest allies. When we see them in vulnerable situations, we have an opportunity to reach out to them to deliver the message about what is going to happen to them and their health care. But sometimes we miss the opportunity.
-Gerald B. Healy, MD
There was a time when hospital boards were composed of people who were really community giants, people who supported the symphony and the arts, and who really understood that some areas will lose money but must be supported. For example, in a pediatric hospital, genetics is going to lose money, but you need to have geneticists, Dr. Healy said. Now I look at boards, and they’re mostly composed of business folks. In their eyes, patients are widgets, and what we do in the operating room is an assembly line.
Culture Clash
This has all happened because the doctors haven’t done their part to establish their hospitals’ cultures, Dr. Healy said.
Whose fault is it if the culture of our hospital changes? It’s yours and it’s mine. Because, for too long, we have been too busy operating, he said. We have abdicated all the responsibility, because of time constraints, to other people to set the culture of our hospitals. And they’ve done it, and now we’re standing around scratching our heads: ‘Why can’t I get this done? Why is it always bottom-line driven?’
Dr. Healy took on the $400 billion-a-year health insurance industry, saying that if he can use an ATM to get money from his Boston bank while he’s in Phoenix, then surely we can process health care claims electronically without 30-story office buildings and a massive infrastructure of people sucking all this money out of the system.
Premiums rose 117% from 1999 to 2008, according to the Kaiser Family Foundation and Health Research and Educational Trust survey, he said.
Is there a single patient inside the borders of the United States who’s healthier because of an insurance carrier? he said. These [insurance] folks are a major problem.
Dr. Healy also took a swing at the plethora of companies constantly cranking out new devices and machines that, he said, are all too eagerly purchased by hospitals in what he called an unrestricted medical arms race.
The reality is: They make it, we buy it, whatever it costs, Dr. Healy said. Especially if the hospital down the street has one and we don’t. We’d better get it quick because we’ll lose the business to them. The question is: Do we stop and evaluate how useful is all this to the real outcomes of our patients?
He urged the audience to take on leadership roles in organizations, their communities, and their own hospitals. Every person in this room can leave here and be a leader, he said. You don’t have to have the word ‘president’ after your name to be a leader. You just have to be someone who’s about excellence-not commanding, but building it.
AHNS President Wayne M. Koch, MD, said the address was fabulous.
You gave us a lot to think about, a lot to talk about, he told Dr. Healy.
Jatin Shah, MD, Chief of the Head and Neck Service in the Department of Surgery at Memorial Sloan-Kettering Cancer Center in New York, said, The issues that he rose were truly real-time issues.
He said that Dr. Healy touched on a problem that is unfortunate but true.
Surgeons are very self-centered, Dr. Shah said. We live in a cocoon. He added, Leadership from within the surgical group would be the right way to identify the problems, look at the solutions, and bring it up to the government.
©2009 The Triological Society