Wednesday, June 10, 2015

Are Some Physicians Stockholm Syndrome Victims?

A hostage sides with her
captors in a bank hold-up
Years ago, when the Population Health Blog was the staff physician supervising an overworked inpatient consult service, its team of residents was asked by a surgeon to evaluate abnormal kidney function tests on one of her patients. After quickly surmising that the cause was a simple case of easily-corrected dehydration, the residents complained that the surgeon should have spotted the diagnosis. As a result, they said, this was a waste of their time.

"Not so!" said the PHB. It pointed out that the resident's medical knowledge was so advanced that they could glance at some lab numbers and spot the diagnosis. It's not that the surgeon was dumb or lazy, but that they were extremely smart.

The PHB also challenged them to snap out of it. Their low self-esteem was allowing them to be held hostage by narrative that not only devalued their expertise, but put their professional well-being at risk.

Fast forward to today when it's not about troubled kidney function, but a troubled healthcare system.

As we look for solutions, physicians are being buffeted by a widespread narrative that they're largely responsible for low quality, high costs and poor patient experience.

For example, there's literature that physicians order too many or (too few) tests, that misdiagnosis is common and that their treatments warrant scrutiny.  Or, thanks to their "power of the pen," misaligned physician incentives have led to the United States' outlier status on life expectancy vs. per capita costs.

How much is truly under the physicians' control is up to debate. What's more, physicians bring tremendous value to the table of health reform.  But, public perception says otherwise, and that's likely playing a role in the declining public trust in physicians and drops in their prestige. That, in turn, is contributing to widespread professional dissatisfaction and burn-out with significant implications for patient care.

Which makes the PHB wonder if it's witnessing the consult service scenario described above, but on a national scale.  It's one thing for its physician colleagues to emotionally struggle with the tectonic challenges of health reform (and there are ways, like this and this, to deal with it), but it's entirely another thing for them to agree that their professional value has been diminished.

Which leads the PHB's to speculate about its biggest fear. In addition to the hassles of physician-owned practice, the intellectual and emotional buy-in of a narrative of incompetence may be leading many docs to willingly outsource national policy as well as local practice decisions about quality and costs to the corporation.

For some docs, this could be a professional version of the Stockholm Syndrome.

As so elegantly described by Paul Levy in his blog, the Stockholm Syndrome occurs when hostages misinterpret the near-term lack of abuse by their captors to the point of emotionally bonding with them. While he was writing about the relationship of healthcare institutions to electronic record vendors, the PHB wonders if the same could be said about the relationship of physicians to their administrators, policy makers, elected representatives, regulators and the other clerisy.

Their reward for any role they've played in marginalizing physicians is greater authority, and some docs may not only going along with it, but embracing it.

The PHB looked for physician surveys or other data to support this, and can't find it. It suspects no one has asked the question.

Until now.

No comments: