In response to a Lofty Thinker:
Hear, hear! I am frustrated and baffled by the appearance of this statement:
“To get there, though, physicians will need to give up the traditional craft-based approach to medicine. For the last 100 years or so, medicine has consisted of an individual physician putting the healthcare needs of an individual patient before any other end or goal. The physician draws upon his or her clinical knowledge to develop a unique diagnostic and treatment regimen that is customized for each individual patient.
Unfortunately, healthcare has simply become too complex and costly to rely on this craft-based approach to deliver the right care to the right patient at the right time, every time.”

This is a manifesto of Fordism in medicine. Many of these ideas were cast out of the business schools, with loathing, after the World War. THE World War, in 1920 or so. How come we have dredged up these dreary Modernist zombies and set them in search of brains?
Modernist thinking says one size fits all, and it’s cheap. Postmodernist thinking goes towards bespoke product. Modernism talks about shoe size; postmodernism produces $100 shoes custom to the size of your feet.
If one wishes to see Modernist healthcare, there’s some in Haiti, and Ghana and Togo. Those who have the money to pay for the quaint old system of craftsman medical care have it, and plenty of it. but the other 95% of the population goes to the pharmacy. All of the drugs are direct-to-consumer (see what patient empowerment they have in Togo and Haiti!) and the consumers make their educated choices. They don’t have iApps to help them; they don’t have shoes. But they DO have freedom of choice!
Healhcare in Haiti is as six-sigma-lean as the patients themselves are. Skeleton-lean, you’ve got to admire that. Ghana itself is actually moving to increase their public health coverage and is doing and admirable job of it – actually putting their citizens first.
We are hearing the soft and crappy politics come in once again. You know, these issues of improving primary care, removing impediments and empowering patients are clearly well documented from the 1990’s. Some of them have failed miserably, atrociously. A fix is tried, it does not work – and the politicians rebrand it and trot it out a few years later as the New Fix to the problems caused by the Old Fix.
The old profession of “Doctor” will be exterminated in the same way “Nursing” was murdered twenty years ago. Of course, there will always be a serf to hang the sign on – there are still Nurses. Look what fifty years of out-of-the-box motivationally-driven change have done to the nursing profession!

Once the Goose that Lays the Golden Egg is killed and the postmortem proceeds, once all the profits come rolling in when doctors are eliminated, then – we’ll have a New New Fix! Good luck with all that.

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