Editor's note: Our August cover story highlighted medical education programs that incorporate managed-care experience into residency training. In this article, one expert on medical education talks about the challenges ahead as healthcare becomes increasingly driven by consumer demand.
Little agreement exists regarding the changes that are reshaping healthcare in America.
Supporters believe the changes will bring efficiency to medicine and help the U.S. healthcare system increase its focus on improving community health.
Critics think the changes have the potential to limit or remove healthcare professionals' authority, turn healthcare into a for-profit enterprise, call into question the traditional hold of healthcare guilds and endanger public health.
Probably all these descriptions are true, albeit a bit exaggerated. One thing that does seem to mark the transition in healthcare is a fundamental movement from a supply-based system to one that is demand-driven.
Given the spread of managed care and the rise of new technologies, physicians need to be trained to return their focus to the patient. Such training would help doctors personalize patient services in an increasingly impersonal healthcare industry.
The healthcare system is shifting from delivering care in whatever manner it chooses to allowing recipients to ask for what they want and receive it.
The most obvious changes are happening among large purchasers. Employers and business coalitions are demanding that health services incorporate three components: reasonable cost, patient/consumer satisfaction and overall comparable quality.
Beyond this corporate driver of change is an even more radical mechanism: the aggressive individual consumer of health services. As individuals assume more responsibility for the financial dimension of their healthcare, many are becoming far more assertive about how and when they receive these services. This means the healthcare professional will have to assume a dramatic new role.
First, providers no longer will control health information in one-on-one interactions with patients. This will fundamentally alter providers' approach to patient interaction. An increasingly important role for the provider will be learning how to promote consumer access and use of independent information on the Internet as more healthcare data warehouses go online.
In this regard, the physician may be more valued as a coach, interpreter or counselor than in the past. Some patients may always want doctors to make certain decisions for them, but many patients want to be more involved in the healthcare decisionmaking for themselves and their families.
For medical education, this means a radical reconstruction of how knowledge is approached. Effective practitioners will need communication skills that focus on changing patient behavior. The physician will need to be acutely aware of his or her skill level in areas such as patient feedback and conflict management.
By and large, helping students develop such capacities is not a major part of most medical training. The situation is not unlike teaching at the university level. Though well-versed in the discipline, the typical university professor has had little, if any, training in teaching and has had few opportunities to receive feedback from colleagues or consumers.
To incorporate such training into a physician's education does not require massive changes in the curriculum. In fact, a few inexpensive alterations could have a major impact.
Students should take and receive feedback on a battery of psychometric tests that examine how they view and engage in the world. The Myers-Briggs Type Inventory, FIRO-B, SYMLOG and other readily accessible psychometric instruments can offer students extremely valuable insight into their world views and how they differ from those of other students. Test results are useful in predicting how students will interact with colleagues and patients.
Some schools, such as the University of New Mexico, have changed their admissions policies to reflect the importance of communication skills.
Students should also be trained and encouraged to give one another feedback about their ability to interact with patients and colleagues. Coaching one another can be enormously helpful to students. The University of California San Francisco, for example, offers a course in which students from various disciplines give one another feedback about how effectively they work as team members.
Another valuable learning tool is having students design, implement and evaluate the results of a patient satisfaction survey. This exercise can be even more powerful if the survey results are then analyzed with consideration of the students' psychometric test results.
Most of these teaching strategies involve little extra money or time, but they do require the faculty's commitment to supporting the development of critical consumer attitudes within students.
The old healthcare system rarely has been accused of convenience, but the emerging one will have that orientation. Phone consultation, easier pharmacy renewal and updating, online information and patient-held records all are part of the new system.
As things change, patients and payers will expect two things: comparable quality and pleasant service. Every healthcare practice must be able to demonstrate the first with empirical evidence and the latter in its patient interactions.
To remake the physician practice and to respond to this new demand-driven system will be a significant challenge. Focusing on these changes will be essential to success in the emerging system. Another significant reason to move forward is that many of the outcomes clinicians were unable to achieve in the old system will be possible in a new partnership with the consumer.
Edward O'Neil is co-director of the Center for the Health Professions at the University of California San Francisco.