Self care always sounds like a good idea in principle – until it starts to impact your bottom line as a clinician. That may sound a little outrageous at first, but in harsh reality (and given the state of incentives in our reimbursement structure) it isn’t far from the truth. As much as health care providers espouse beliefs of “wanting the patient to become independent”, independence ultimately means no visits and no reimbursement. Clinicians straddle a fine line between these two conflicting issues of “independence” and “economic survival”.
The issue of self care is an intriguing discussion with other clinicians. If you delve deep enough, self care is almost perceived as a threat.
The question is this: is self care a threat to traditional health care as we know it, or is it the next great disruptive innovation in health care?
The traditional approach to health care in this country is visit- and expertise-driven. You need to see a clinician because they are the “experts”. They will “fix” you and the insurance company will reimburse them for your visits. “Lather, rinse, repeat” as they say.
Here is a conversation that could very easily (and has) taken place between two clinicians:
Clinician A: Mr. Jones needs to come to see me for [insert number here] visits to fix this problem.
Clinician B: Why does he need to come in for so many visits?
Clinician A: Mr. Jones will benefit from getting the appropriate treatment from me. Based on my clinical experience, Mr. Jones needs to come in for the necessary [insert treatment here: manual therapy, exercise supervision – all billable items].
Clinician B: But what if Mr. Jones could be educated in a way that he could not only monitor his own progress, but make appropriate decisions in the progression of his own program?
Clinician A: Mr. Jones will still really need to see me. The patient doesn’t have the knowledge that I have in order to progress his treatment appropriately.
Clinician B: But what if Mr. Jones has the tools to solve this problem himself? Couldn’t he just use his own self-generated forces and postures to accomplish the same things?
Clinician A: (Now getting a little defensive) Well, I am the one that will be able to fix them. And if we don’t see Mr. Jones here, then how are we ever going to be paid for what we do? (rummaging for more billing sheets) He will just go elsewhere for his treatment anyway if he doesn’t get it here. Besides, we need to make sure he is doing his exercises correctly for his benefit.
Clinician B: But aren’t we trying to promote independence? Shouldn’t Mr. Jones’ solution be driven by self care strategies? Is there really a value-added benefit for Mr. Jones if we watch him do his exercises here, or if his treatment here is redundant with his self treatment at home?
Clinician A: Mr. Jones needs to be compliant with his home program while still coming in for treatment. He needs us for our depth of knowledge, our education, and our intimate understanding of the situation! And besides, we don’t want to become expendable, do we? If a patient could self-treat, then why would they want to see us?
Clincian B: Mr. Jones will want to come see us because [insert clinical profession here] have the capacity to solve problems and promote learning … something that allows the patient to be mentored, not fixed. We provide a patient with a great experience – that alone provides value and meaning to a patient.
If you believe that patient independence is key, then isn’t the goal, by definition, to make the clinician expendable?
Self care shouldn’t be viewed as a threat to traditional health care. Far from it. But I would also suggest that many clinicians do see it this way. Self care decreases visits, a potential economic nightmare for any clinician. Thinking in terms of true patient-centered self care requires a clinician to formulate a new business model, a new way of adding value and creating not only a great patient experience but building a culture and ecosystem to support it. It requires re-imagining your role as a health care provider who’s sole task is to be accountable to the patient and their independence, not their insurance reimbursement. In fact, self care is the ultimate expression of disruptive innovation in health care.
We have seen it in nutrition, in fitness, and in personal development . Why not in medicine and rehabilitation?
If you truly stand by the importance of self care and patient-centered care, then what are you doing to emphasize this?
Photo credits: nick see