Are Doctors and Patients Changing Roles?

By Roland Piquepaille

Richard Bohmer, a physician and a professor at Harvard Business School (HBS), has an interesting theory about "The Changing Roles of Doctors and Patients," according to HBS Working Knowledge. He says that a century ago, patients were more or less passive and ignorant of their conditions, relying on their doctors for diagnosis and decisions. Now, patients can use tests to check themselves for some conditions, such as diabetes, high blood pressure or pregnancy. And thanks to the Web, they're also more knowledgeable, sometimes even requesting specific medications or treatment. On the other hand, doctors, especially in large organizations, are taking new roles as managers or system architects. Obviously, even if this analysis is true, it applies only to a very small number of developed countries. If you're a doctor, how do you see your role changing? Read more below before posting your comments...

Richard Bohmer, who spoke on "Changing Models of Healthcare Delivery" at the 5th Annual Alumni Healthcare Conference on November 5, 2004, teaches the MBA course on managing healthcare technology and operations. He is also a physician trained in family medicine and public health. He introduced his talk by discussing how much has changed in healthcare and, to a degree, how much has not.

First, what hasn't changed for doctors?

Physicians are still ethically bound to "treat all comers" who need medical care. And risk selection among patients is frowned upon from an ethical standpoint, said Bohmer. Despite all our medical wisdom, the outcome of treatment is still often uncertain, he said. In addition, new diseases such as AIDS, SARS, and avian flu continue to emerge, while obesity, menopause, and old age -- which were once phenomena -- have become medical problems, he said.

Now, let's look at what has changed for them.

Until the nineteenth century, a physician was more or less a solo pioneer. He was an experimenter, decision maker, and the person who carried out the decision, all rolled into one. In the twentieth century, roles changed and physicians were less likely to be experimenters, acting more as decision makers and clinical judges. Now in the twenty-first century, the doctor often has a new professional role as manager and system architect.

Bohmer also said that the role of the patients also evolved.

Not long ago, they were still relatively passive, ignorant of their condition, and dependent on the doctor's advice. But now they can choose self-testing for at least some conditions such as diabetes, high blood pressure, and pregnancy. A small but determined cadre, said Bohmer, are making rules-based decisions for themselves.

Another big change is the shift from individual doctors to large medical organizations, with several important effects.

The shift from lone doctor to wide organization has critical implications for operations design, the structure of the medical industry, and practitioners' -- as well as patients' -- roles, tasks, and boundaries, he said.

One organizational structure that has emerged is based on the "sort and reject" strategy of risk selection, said Bohmer. Certain hospitals specializing in cardiac or hernia care often do more sorting and rejecting of potential patients than we would like to believe, he continued.

Bohmer, who is involved in teaching MBA courses, seems to admit there that doctors, who should treat everyone needing medical care, don't always do it, and for financial reasons. Frightening, if true.

And what about the future, still according to Bohmer?

The development of programs and tools for patients to take more control of their health is based on "a very important new assumption about how competent patients are," said Bohmer.

"Not all patients are going to want it. Many patients are going to much prefer a rather more paternalistic relationship with their physicians, and that will be fine. [The preferences] will probably shake out by generation.

Now that you're read about -- the somewhat provocative -- Bohmer's ideas, do you think he's right? Maybe he is, but for a very limited amount of doctors around the world. Even in the U.S, I doubt that Bohmer's theory is valid in many rural communities.

And you, what's your take? Do you believe that doctors -- especially in large organizations -- are becoming system managers? Please post your comments below.

Source: Martha Lagace, HBS Working Knowledge, November 22, 2004

Related stories can be found in the following category.

• Medicine