Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is a fourth-year Harvard medical student. E-mail her at firstname.lastname@example.org.
Last month, I ventured out of my comfort zone to take a course at the business school. It was a seminar on competition in health care delivery, and while the subject matter was somewhat familiar, the approach was anything but.
The professors for the course, Michael Porter and Elisabeth Teisberg, are taking an outsiderís look at The Big Question of how to fix health care. They champion what should be a simple math problem: divide health outcomes by health costs and compare the quotients across doctors and hospitals to drive better care.
The trouble is that outcomes are rarely measured (they are talking better health and quality of life, not just patient satisfaction with magazines in the waiting room), and ditto for costs. Some health care systems, like the Cleveland Clinic in Ohio and the MD Anderson Cancer Center in Texas, are doing such work, with a focus on patient-centered care. So during the seminar, we read detailed case studies of such hospitals and often met with their leaders.
The course brought together everyone from Partners HealthCare management to surgical residents and MBA students interested in health care, and the discussion was rapid-fire and often contentious. Through these cases, we put names and often solutions to observations that many of us have had on the wards -- like problems with documentation and inefficiencies in the hospital system.
On my advanced medicine rotation, I remember how difficult it was to coordinate the various specialists who needed to weigh in on my patients' care. But several of the hospitals we learned about have centers organized around conditions such as back pain or breast cancer, with teams of specialists who make it a habit to talk to each other regularly.
It was a refreshing change from medical school, not just because of the complementary lunches and the chance to meet classmates with fascinating backgrounds. I was thinking about my field in a totally different way, one that we know (from studies on health care quality and the discussion in Washington, D.C.) is critical for all doctors to understand.
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