Last week, inspired by the Independence Day holiday, I wrote about the important distinction between independence and autonomy. I made the case that professional autonomy is not about each doctor doing as he pleases, but about physicians as a group taking responsibility for shaping medical practice.
I was pleasantly surprised over the holiday weekend when I came across a recent paper in Health Affairs that illustrates how effective physician leadership (autonomy) can reduce unnecessary practice variation (independence) and improve clinical care. The paper also reinforced some of my earlier thoughts about the central role that physicians must play in redesigning systems of care. Continue reading More on Physician Autonomy
I had the privilege recently of teaching a course on “physician leadership” as part of the North Shore –LIJ “Physicians High Potentials” program. For those of you who are not familiar with the program, it provides training and coaching for physicians in the health system to enable them to take on formal leadership roles, and covers topics as diverse as how one’s own personality affects communication with others and health care financing.
At the start of the session (which I taught with Dr. Vicki LoPachin), I tried to give a brief overview of why physician leadership is so important, and why I believe it is an extension of the more traditional “healer” role of physician. My argument, which drew heavily from the work of Richard Bohmer, went something like this:
Physicians have always felt a keen professional obligation to improve the health of their patients. In the current parlance, we have always tried to improve patients’ outcomes. For most of recorded history – indeed until recent decades, physicians practiced mostly as independent craftsmen (and yes, they were almost always men) with a general ignorance of causes of disease and limited therapeutic options. Patient outcomes, to the extent that they could be improved, depended on what we knew and what we did to and for patients. Continue reading Physician Leadership