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In the age of spiritual machines Ray Kurzweil in 2001 predicted:
By 2020, a $1,000 computer will match processing speed of the human brain – 20 billion calculations per second
By 2030 it will simulate the brain power of a small village about 1,000 human minds
By 2048 it will have the brain power of the entire population of the US.
I predict that within 20-30 years the computer will replace the venerable physician. Computers can already be programmed to detect sarcasm and read emotions. They can study your face and body language. Computerized psychotherapists or cybertherapy is soon to come. Programs can detect deviation from the standard pattern of human physiology, thinking and behavior. We can already program standards of care and integrate it into an electronic health record. The U.S. government program of Meaningful Use is forcing the adoption electronic health record use in 3 stages by 2017. As always, encouragement is by reward initially, followed by penalty in the later stages.
Now as you sit in a doctor’s office, you are likely yourself talking to yourself rather to your doctor who’s not spending any face-to-face time with you. He or she is likely staring at a computer screen and typing notes as you speak. Because of physician shortages or need to meet RVU targets (unit measure of patient care), your doctor has 10 to 15 minutes to spend with you. During that time your doctor has to document all key elements of the visit and check off various measures Meaningful Use but if you are lucky, a minute will actually be spent on a limited physical exam.
Compare that with the experience you had when you were younger. Decades ago my old family doctor sat in front of me, talked to me and talked with me. He would jot a few notes on paper. I got an examination and a treatment plan. He made me feel as if I had spent a long time with him. I would call that “meaningful.”
As the government, health insurers and hospitals demand greater efficiency, more documentation and of course, error free care, it is in their best interest to replace us with machines. There will no longer be any medical errors, malpractice will become history, and your doctor won’t be exhausted or troubled with anything so trivial as feelings. Who needs that sort of interaction because you are only here for a service. In the near future, we will be talking to a computer with voice recognition. We won’t miss the warmth of a patient-physician relationship since that will have been bled from our experience and our memory. It would be like the depiction in the movie, Elysium, when Matt Damon talks to a computer rather than a human parole officer with hilarious results.
Earlier this month I read a Wall Street Journal article about Zeynep Ton's Good Jobs Index. Who is Zeynep Ton? She is a professor at the Massachusetts Institute of Technology’s Sloan School of Management who has ranked retailers on employee happiness. This was so positive. It was good to hear about businesses concerned about employee happiness and not just about profits and shareholders.
Two weeks later I was dismayed to read about the bruising work environment at Amazon in the New York Times. The article described a work environment toxic to workers overseen by a CEO who is blind to this view.
Last year I left a hospital that was an ideal model of health care in the President's eyes. Time Magazine had published two articles about that hospital. Yet my experience there as an employee was closer to the abusive atmosphere the New York Times detailed about Amazon.
I imagine that my old workplace could continue avoiding accolades from its employees by following these 14 steps:
1. Ensure there is a top-down management style. You cannot have middle managers like Department Chairs speaking on behalf of doctor employees. Instead just have the Department Chair spread edicts from higher up down to the masses. Upper management should remain uninterested in employee concerns.
2. Make sure there is no Doctors Lounge. That would only encourage restless employees to congregate and complain about management and the system.
3. Quarterly staff meetings should only be about the CEO and upper management decisions that have already been made for the employee physicians. Pretend to listen to employee concerns but remember, the meeting is really not about them but about upper management.
4. If any employee physician complains of burnout let them know they are welcome to leave and that they are replaceable.
5. Make sure that performance measures are impossible to reach and tie reimbursement and bonuses to these measures. By withholding monetary bonuses from doctors, think of the savings the system will accrue.
6. Since you really cannot measure or quantify caring, you should instead focus on irrelevant metrics that will frustrate your employees.
7. If your doctors stand up to patients by refusing to overprescribe narcotics or use antibiotics for viral illness, then when those doctors get poor patient reviews, make sure they are singled out to demean them and make them feel worthless. After all, great patient reviews are more important than providing great medical care.
8. Each year while the hospital cuts expenses, it should demand greater productivity from physician employees. When the doctors ask for more resources, more support staff or extra clinic time, tell them this is impossible because of expenditure cuts.
9. Take away coffee in the Operating Room nurses lounge because this will save the hospital money. That will have little effect on staff morale.
10. Brag that your CEO is a physician like many of his thousands of employees but make sure the employees know their place in the system by paying the CEO 40 times their average salary.
11. Remind your doctors it's more about numbers and quotas than patient care. If they do not meet RVU production targets their job is at risk.
12. When your doctors reach their 60s, don't treasure them. Instead find a graceless way to get rid of them. Younger docs are cheaper to hire. Remember that experience and wisdom are overrated.
13. Managers should set the standard for "work-life" balance by showing it is OK to ignore your spouse and children and OK to spend as much time as possible at work. The proper balance should tilt toward more work than life. Remind your workers the system is more important than family. The hospital is your family, 12+ hours a day. When you retire, you may find you have no family to go home to.
14. When doctors quit, don't perform exit interviews because you really don't care to know why they're leaving. You're just happy to get rid of them, so just show them the boot on the way out.
The lesson I learned was that I have to work in a Great Place, one that cares about its employees. If you are not in that great place, then leave.
Organizations should avoid pushing employees to do more and more in a thankless environment. A hospital should focus more on caring for patients and their staff and less about meeting quotas and upper management happiness.