January 23, 2015

Doctor and patient

Both doctors and patients see that changes are needed in primary care. Credit: DIBP Images / Flickr Creative Commons

It’s been an epic flu season, and that means lots of visits to the doctor – involving vintage magazines, long waits, and short appointments.
 
No surprise, the current system doesn’t work well for doctors, either.
 
Rushika Fernandopulle, a doctor at Mass General Hospital and CEO of Iora Health, says a colleague once described to him the stress of being a practitioner. “She said, ‘Every day I lose a little piece of my soul. I went into this to try and take care of people and be able to meet their needs, and in the current system with seven-minute visits…and all this junk we’ve piled on, I just can’t do my job.’”
 
The hurried visits and paperwork aren’t the only issues impeding innovation.
 
“There are a host of antiquated laws that are in the way,” explains Fernandopulle. “The telemedicine laws, which say that you have to be in the same state as the person you’re treating, they came about in the 1800s when you didn’t have telephones and didn’t have Internet.”
 
The laws also vary state-by-state, creating a confusing patchwork of regulations.
 
However, both Fernandopulle and Dr. Ateev Mehrotra, from Harvard Medical School, are optimistic. “You do see models emerging that can deliver primary care, I think, in a better way,” says Mehrotra.
 
Many of these new models involve rethinking what doctors have to do. “There’s no reason you have to go to your doctor to get a flu shot. Doesn’t require much judgment – just stick a needle in your arm,” says Fernandopulle.
 
Mehrotra agrees: “A lot of the aspects of chronic illness management in terms of diabetes and hypertension don’t require…seven-minute visits. That care can probably be delivered more effectively by other providers, working with a physician.”
 
Of course, the ultimate driver in changing health care comes from consumers, and Fernandopulle sees people “voting with their feet to these retail clinics. They’re voting with their feet to these Internet services. They’re voting with their feet to new model practices.”
 
In our full interview, Fernandopulle tells the story one patient who exemplifies the problems in primary care. “She’s on 28 different medicines, and they’re prescribed by 11 different doctors. And it’s clear these doctors don’t talk to each other because she’s on seven different antihypertensive medicines – three of which are the same.”
 

Rushika Fernandopulle, Body and Mind, Ateev Mehrotra, doctors, medicine, healthcare

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