The Demise of Independent Physician Practice: Technology, Policy or Tunnel Vision?

Updated: Jul 2

Originally published by Hackernoon on Medium

Photo by Jessica Devnani from Burst

Physicians are a peculiar breed of professionals. They usually take pride in what they do and are always willing to take that extra step when necessary. They generally put their patients before their interests. For that reason, it takes overwhelming dedication, diligence, discipline, and hard work to earn the title of "M.D.." An expression, the medical profession is a lifestyle of discipline second to the military is commonly prevalent among physicians or at least those I can convey. It requires vigilance and organization and is ready whenever needed. Failure to adapt is considered shameful; thus, giving up is taboo.

Despite all said, unfortunately, there is always room for exceptions to that rule. Some burn out, a few make mistakes, or even become negligent. But most of the latter probably points to how one can deal with the rugged nature of the doctor's lifestyle.

Tradition, Discipline, and mastery of Medicine and the doom of the Tunnel vision

As a junior intern, I recall rushing to the morning report after a 36-hour tenacious sleepless call taking care of my patients. It was my turn that morning to present one of my compelling cases from the night before to the audience of one hundred physicians. As confident as I was about my diagnostic workup, cruising confidently down my differential diagnosis list, that was it! There was one that I miserably missed! That was the first, and the last time I was drilled to the hot seat. No doubt, it was one of my worst professional experiences ever. Yes, "tunnel vision."

Of course, even though missing that one differential did not affect my concluding diagnosis, I could read from his expression that the attending physician was not exhilarated. Being in the spotlight, by all means, is probably one of the vilest if not the most demeaning experiences for a typical medical doctor, more so if in front of a large audience.

Due to the traditionalist attitude, physicians inherently are bound to certain platitudes dictated by moral standards. Hence, they will strive to avoid negative feedback whenever possible. Even though sound intended, a stance significantly burdens physicians' personal lives, often causing fatigue, anguish, and burnout.

Clash of culture, norms, and ethical obligations surrounding the medical profession The culture and norms around tunnel vision is by no means exclusive to diagnostics as it often swirls repeatedly around healthcare.

The rhetoric's like One should define and apart between business and the practice of medicine; I only want to practice medicine; health insurance is the healthcare; healthcare is a right; we need to demand politicians for better healthcare, and so on have spitefully evolved within the sociopolitical darkness of physician life.

As medical professionals, it seems like we have found ourselves at the center of these sprawling woods, where all we appreciate are pieces of the landscape around us.

Medical Doctor, Job, or lifestyle is the question!

Medical practice is and will always be a lifestyle. That won't necessarily be due to the retentive sleepless hours or commitment to the patients. Thus far, merely because medical practice entails a multitude of social, ethical, personal, political, and economic influencers that every physician must contemplate when trying to perform at the top of their professional expertise. And for that, they need to narrow down their blind spot by stepping out of that forest. That too invariably applies to contributors to healthcare administration.

As the norms, ethics, and culture around medicine have been turned into an elephant in a dark room by misconstrued driving factors, the letdown of independent medical procedures will be rendered unsustainable.

Similarly, over time the ethical standards of medical business have also been the object of adverse attempts, expectedly to the malignant corporate takeover of healthcare primarily by the Healthcare Management Organizations and recent Hi-tech industry. The narrative of "technocracy" is on the brink of explosion. Outcome! Start of a sweeping and unethical non-medical industry expansion within patient care, shrewdly, every corporation's leading strategy and mission prioritize its fiscal advantage. The foundation of which is the blinded denominator in the healthcare equation, the so-called "Independent physician practice."

The Controversy behind the Practice of Medicine and the Business of Healthcare

It is not only deceitful but is also inattentive to assume for even one minute that a "good physician" should never be rewarded or compensated (either directly or indirectly) for healing a patient, be it through a value-based model pay for service or any business deal. If we intend to take medicine out of the dehumanized trap of corporate culture and place it where it belongs, i.e., "Physicians practice," then norms, values, and morals around the business of medicine must change.

From the advent of the software technology revolution, harnessing the technological potential to address the unending healthcare challenges has been the sole point of focus of current resolutions.

Electronic health records (EHR) were developed to help streamline the health information creation, storage, management, and sharing among physicians and providers through advances that have repeatedly stumble into a particular set of tunnel visions. Hence, by enhancing billing and scheduling features, insurance industry protocols, and overlooking the physician use-case requirements.

The eccentricity that lean business practice and efficient billing is the solution to physician burden and burnout has been proven again and again to be counterproductive and has turned out to be the source of dissatisfaction in the medical community.

Similarly, the Constant political Partisan approach to healthcare issues has taken the practice of medicine out of its context. Healthcare should neither be an object of the national dispute nor something that needs to be reformed by the hands of politicians. Observing Healthcare with the political telescope has magnified the already presented visions of industries' misguided solutions.

Norms and ethics about politics necessitate the type of solutions that will not only evade obstructing the practices of medicine but only center on legislation that ensures quality care and avoids conflicting with clinical judgment.

Credibility issues, biased thoroughness, resistance to change, and tunnel vision are the limiting elements for any advancement and effective delegation. It takes constant self-awareness, proactive engagement, and accepting that there is always more than one side to every problem and variety to the school of thought; tunnel vision theory is more about focusing on intended perception vs. objective presentation.

As the fundamental necessity for stepping out of the woods, we need to look at the big picture, use different glasses and seek an appraisal from various viewpoints. Consequences of the tunnel vision are disappointment hence the demise of independent physician practice.

Policies synchronized with Medical Practices vs. businesses and Technologies are fundamental to Quality Healthcare.

The disproportionate bylaw does not equal superior healthcare, nor does it help the development of the best of the best. The government must look at healthcare through the physician's lens as an alternative to observing through the telescope of insurance carriers. The tunnel vision created by corporate industries through which administrations look is the slenderest when focused on physicians and the patients.