Gone are the days of “your doctor.” In the past, the family doctor might care for you both in the community as well as in the hospital when needed. However, today if you’re sick enough to require hospitalization, you’re far more likely to be cared for by a stranger, a specialist with additional training in the types of problems likely to occur during your stay. This person is likely to be part of a physician team, a group of individuals who care for you at 8-to-12-hour intervals—in other words, shift workers. These changes have been driven by the increasing complexity of modern healthcare as well as the need to improve efficiencies and reduce costs. However, this fragmented care has trade-offs for both patients and providers.
The Patient’s View: Who is My Doctor?
For many patients there seems to be a revolving door of care providers during their stay in the hospital, but often no real captain of the ship— no person they can relate to as their physician. This can be confusing and anxiety provoking. With no central figure overseeing their case, many patients worry their care team doesn’t understand them or hasn’t taken their concerns into consideration.
The Provider’s View: What Does My Job Mean?
For many providers the move toward shift work has disrupted both the intellectual and emotional satisfaction driving the initial choice to enter medicine. In his book, Why We Work Barry Schwartz notes that people want to see value in their work. But when patients come and go with no real follow up, it may be harder to see the contribution we make as providers. Shift work tends to be more routine and rote, robbing deeper meaning from what used to be seen as a vocation rather than simply a profession. And while money certainly enters the picture when it comes to an individual’s motivation to enter a particular field, as behavioral economist Dan Ariely points out in his TED Talk, money is rarely the only motivation. Sadly, whereas many physicians went into healthcare based on intellectual curiosity, the business of medicine may be creating environments that in some ways stifle creativity—the process of diagnosis and discovery.
Restitching the Fabric of Care through the Continuum
Care shouldn’t start and stop at the hospital door. And a critical part of care is ensuring the patient understands the prognosis. While the level of a patient’s acuity clearly differs between community and hospital medicine, it’s still the same patient. Opportunities to improve might include:
- Clearly defining a captain of the ship who integrates all the messages from the various specialties and then communicates to the patient and her designated community provider.
- Conversely, providing feedback to the hospital staff about the patient after discharge. We did a small pilot here at Dignity Health where patients were able to comment on their care more actively to their nurses and doctors. This did wonders for the morale of the hospital staff.
- Changing the culture from one of getting the patient to discharge (the current reimbursement model) to getting her back to wellness (tomorrow’s value-based care reimbursement model).
Shift work is not going away. The business of medicine demands this new paradigm. However, a renewed emphasis on communication provides a real opportunity to improve the experience for both patients and providers.