In the U.S., the consumer rules.
You want “free”, next day delivery on a pair of pants? You get it. Refund on a more than gently used product you’ve had for 90 days because you aren’t 100% satisfied? You get that, too.
U.S. consumers demand convenience, efficiency and low costs, and consumers expect companies to bend over backwards to accommodate their needs. What’s interesting is, U.S. companies will do just about anything to keep consumers happy, spending untold, but likely obscene, amounts of money to delight consumers, keep them loyal to the brand and most importantly, boost their earnings to look good on Wall Street.
It’s a never ending cycle that transcends industry from retail to food to entertainment and everything in between. I’m curious, however, to study the impact of consumerism in heavily regulated, complex and traditionally luddite-like industries such as healthcare.
Why? Because if you live in the U.S., it’s arguably one of the most emotionally charged, insanely expensive and ambiguous purchases you’ll make as a consumer (e.g. in what other industry do you purchase a service and have literally no idea how much it will cost you until you get the dreaded “surprise” bill for an astronomical amount?)
On one hand, I’m all for, I repeat, ALL FOR, a more consumer centric approach to receiving and purchasing healthcare services. Namely, consumers want to learn how to better access healthcare services, understand types of and options for services and know how much the services will cost.
On the other hand, I can’t help but wonder, are there any downsides to applying the consumer centric model that industry giants like retail and entertainment, for instance, have adopted?
In this article, I want to explore the possibility of a dark side to consumerism in healthcare and I want to use the rising rates of physician suicide as a means to explain my view.
If you aren’t alarmed by the rise in physician suicides, you should be
I’m haunted by a recent discussion with a friend and emergency medicine doctor, who I will refer to as Jessica.
During our conversation, the topic of physician suicide came up. As we shared theories around the root causes of the increasing suicide rates and possible solutions to address the problem, I was disturbed to learn that she knew, personally, 3 physicians in the past 6 months alone that committed suicide.
Let’s rewind and play that back: she personally knew 3 physicians in the past 6 months that committed suicide.
As we dug deeper on the subject, I quickly found out that her story isn’t unique.
It’s a heart-wrenching irony. The very people that have devoted their lives to caring for others are unable to care for themselves, a struggle so severe that can lead these people to end their own lives.
In trying to understand the physician suicide phenomenon, I quickly came up with a handful of possible, contributing factors like: a highly fragmented, grossly capitalistic, system that puts intense pressure on physicians
As the theorizing surged between Jessica and I, a disturbing thought crept into my mind, “are we patients, consumers of healthcare services, a part of the problem?”. This was a hard reality to face.
Our expectations as consumers of healthcare services are dangerously unrealistic
Key industry players like health systems, insurers and the government are placing an increased emphasis on the patient experience and compensating physicians based on the value and quality of care they provide versus payment based on the number of services they render to patients.
In principle, this is a great concept and there are many valid arguments in favor of this new reimbursement scheme. What is overlooked, however, is the mushrooming strain that is put on physicians’ shoulders to make this radical change happen (e.g. administrative pressure and meeting patients’ demands).
For example, one example of how patient experience is measured is through a survey patients fill out called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). In summary, the CAHPS survey asks patients to report on the aspects of their experiences that are important to them and for which they are the best and sometimes the only source of information.
Is there a real need to gain feedback from patients to improve the way they perceive and receive healthcare services? Absolutely. What happens, however, when patients’ expectations are unrealistic and when such expectations aren’t met? Physicians suffer. Do patients think about the chain of events that occur after the CAHPS survey is filled out or a complaint is filed? Probably not. Let me clarify, there are plenty of legitimate reasons to file a complaint as a patient. When I reference unrealistic expectations, I’m talking about the ‘magic pill’ type of patients, which I will describe below.
“Can you just give me a ‘magic pill’?” some patients will say. This is a real request and it happens way more often than you might think in the healthcare setting. Jessica described countless times where she has fielded that question in the emergency room. Often times, the request is coming from disgruntled patients whose bodies have sustained decades of abuse (e.g. poor lifestyle and behavioral choices) and there is no ‘magic pill’ that can reverse that. I am certainly empathetic to the social determinants of health (SDoH) and how this plays a role in a person’s lifestyle and behavioral choices, but condemning physicians is not the answer. If you dig deeper on the “why” behind this ‘magic pill’ request, you’ll quickly find that it’s a nuance of U.S. culture: for many, there isn’t a real interest in understanding or addressing why we are physically or mentally unwell, we just want a quick, band-aid fix to make the problem disappear. This is neither a sustainable approach to leading a healthy life nor a sustainable way to approach the practice of medicine.
So, what happens when a physician says no to the request for a prescription drug or a treatment they don’t think is suitable for the patient? In many cases, the patient gets pissed off. It’s only a matter of time before many physicians yield to the patient’s request out of fear of bad reviews, punitive action or they are just plain exhausted with battling patients.
So, before you file that complaint or become irritable when a physician doesn’t give you what you ask for, first ask yourself:
- Am I remembering that my physician isn’t superhuman?
- Is my request reasonable (e.g. ‘magic pills’ aren’t reasonable)
- Am I owning my own health and wellness?
- Do I want to just mask my problem or solve my problem?
Improving the patient experience is an honorable goal, but it will continue to have critical, unintended consequences if not approached and managed properly.
Why do we treat physicians differently than we would a normal human?
Physicians aren’t superhuman. Hopefully, most, if not all, patients recognize this fact, but how well is this remembered when we are the lying in the hospital bed?
Physicians have the same human experiences that non-physicians have: feeling the effects of trauma, feeling uncertainty, feeling sorrow and feeling vulnerable, to name a few.
Physicians aren’t invincible, so why do we treat them as such?
From Jessica’s viewpoint, the toxic culture of suffering in silence starts from the time medical school begins. It is considered weakness to show emotion or do the unthinkable, ask for help when it’s needed.
This is insane.
In the wake of several high profile, celebrity suicides like Anthony Bourdain and Kate Spade, every social media outlet from Twitter to Facebook was lit up with stories from survivors and messages like “you’re not alone”, “there is no shame”, “reach out for help” including the suicide prevention hotline number.
This is the exact opposite messaging we convey to physicians.
To illustrate the extent of how misguided we are in the way we address physician mental and behavioral health, I’ll provide an anecdote that Jessica shared with me about a fellow physician named Chris who was applying for a new medical license to be able to practice in a new state. On Chris’ application, he disclosed a historical diagnosis of anxiety and depression. Alongside his application, Chris provided documentation from his supervising psychiatrist confirming Chris’ degree of stability, the name and dosage of his anti-depressant medication and his personal contact information welcoming a phone call to discuss Chris’ case.
In response to his application, Chris was asked to meet with the medical board. When Chris showed up the day of the meeting, he was met by a social worker and was requested to enroll in a 90 day, mandatory inpatient physician rehab program, 100% funded by Chris. If Chris declines, he won’t get his new medical license.
My jaw dropped in disbelief.
Jessica explained that by admitting either historical or present diagnosis of a mental behavioral condition, like depression or anxiety, there will be unnecessary, corrective action taken against you.
Naturally, I asked Jessica a follow up question, “So, because of this, do you think physicians will disclose a mental behavioral health condition?”
Jessica replied, “Many just omit the information from the application”.
Healthcare providers need safe spaces too
Saddened by the stories Jessica shared, my immediate reaction was that of pure helplessness. What could I do as a patient to change this unforgiving environment that physicians reside in?
Upon reflection, I realized there is one immediate, relatively simple thing we can do as patients and consumers of healthcare services to help address the growing issue of physician suicide:
- We need to start viewing our physicians as humans, just like us
- We need to take ownership of our own health to the extent that we can
- We need to be reasonable with our requests
- We need to advocate for our physicians
In emphasizing point number 4, next time you visit your doctor’s office, ask the front desk staff if there is a way you can leave a comment that can be submitted up to health system leaders. Request that there be a program and resources in place to support physicians and create a safe space. If you are reading this article and employed in the healthcare space, check out what The Sharp Index is doing to prevent against physician burnout.
What do you think? I’d love to hear your thoughts!