Lemmings

“OK lemmings, let’s go for a swim.” I would often lead off with this comment prior to starting teaching rounds on the wards. It was a half serious attempt at humor and a reminder to the residents and students that if they followed their leader blindly and without question, we could all go over the cliff (and take our patients with us.)

I am on the train returning from a meeting in New York where we discussed how to deliver better care to more patients, safely and cost effectively. The agenda included the Presidents of The Joint Commission, The National Patient Safety Foundation, and The American College of Healthcare Executives, as well as CIOs and CEOs of major healthcare organizations and industry. The message was consistent and, to me, exciting. There will be increased demand for health care without significant expansion of resources. Yet we have tremendous opportunity to decrease overuse of services, improve the process of providing care, and decrease complications. This will require true realignment of incentives for providers and hospitals, with patients also taking responsibility for their health care. Information technology will not just be about forcing the use of electronic medical records. What if it could provide the patient with the ability to review their labs and radiology, schedule appointments, and pay their bills with the same ease as you check you frequent flier account? Fantasy? No - it’s in use currently at a major AMC in the Southeast. And some of the best stories are of patients picking up on significant abnormal results that may have otherwise slipped through the system.

We will need to change physician and hospital behavior, which is challenging for all of us. This is not just about dangling a carrot. It will require the combination of rules, tools, and norms that must be inculcated into the culture starting with school and continually reinforced by appropriate modeling. The next generation of providers (see “The New Millennials”) are far more comfortable with technology, salaried employment, and an increased balance in their personal and professional lives. They are more likely to engage their community and blur individual boundaries and silos. We can teach them the importance of self examination and open discussion of error. We, as the leaders in medicine, must continue to adapt to the new paradigm and not hang on to the past in hopes of salvaging the old system and its disparate incentives.

Now I’m all for Darwin’s theories of survival of the fittest. There are lots of explanations why lemmings seem to follow each other off the cliffs to the abyss. Be that as it may, I’d love to see some young upstart speak up to the elders that maybe, this time, a right turn to higher land would be a better plan. We have the opportunity to chart the new direction, and lead others. So lemmings, are you ready?