Some thoughts and observations by a practicing anesthesiologist:

1.Improving patient outcomes, improving patient satisfaction, reducing medical errors and curtailing costs etc are very hard problems. There are no easy answers. Doctors know about this( because this affects us also) , routinely discuss it, try to solve/amend whatever is in their power but the overall nature of these problems is such that without nation wide measures and policy changes no concrete improvement can be achieved.

2. Becoming somewhat emotionally detached/blunt etc is a requirement for the job. There is no survival without it. It happens to all doctors. It happens to family and friends of people who end up in hospitals for months. Even with the detachment adverse patient outcomes do affect the treating doctors and this emotional trauma piles up over the years.

3.Same for abrasive personalities. There is so much push and pull going on between doctors of different specialties, between doctors and nurses, between doctors and administration, between doctors and insurance companies, between doctors and patients and their relatives that anybody not strong/abrasive/assertive enough looses his ground which affects both the doctor and the patients under his care adversely.

4.Generally a lay person reading up things on his own doesn't bring anything useful to a discussion with the doctor. Sometimes there are real options in which even the doctor is not sure of benefit/risk ratio. The patients should take decisions in these cases. Same for major operations and interventions. But for majority of cases average lay person is better off following the advice of his doctor than relying something he read on internet.

5. A job of doctor will probably be one of the last jobs to be replaced fully by machines. Just like parenting.

6. Doctors are not against technology or threatened by it. For example a lot of lab tests that are automated now were performed by hand by pathologists.They are very happy to use these new technologies. Their role hasn't diminished. The lack of enthusiasm for health IT software is because most of it sucks.It adds to workload, doesn't provide any value, and adds another layer of responsibility/anxiety. Most doctors will run to anything that only marginally improves their ability to handle workload.

And the list can go on.

Some interventions that might work are:

Checklists. simple, easy to use and practical checklists .

Mandatory leave/ time away from patients. The more acute/emergency oriented/high stress specialty , the more the need. For example I think specialists in Anesthesia/critical care/emergency medicine/gynecology/neonatology etc should have 3 months of leave away from patient care every year to stay sane.

>fulfilled doctors make for more-satisfied patients. Tackling the problems of Kaiser Permanente’s Colorado medical group, he took the counter intuitive step of demoting “patient-centered care” as a goal, and elevated “preservation and enhancement of career” for doctors to first place. He restored to them the sense that their work is, as Barron Lerner’s old-fashioned father put it, a “rare privilege” to be pursued with a sense of responsibility, rather than harried accountability.

ABSOLUTELY TRUE!!

There is promise in healthcare analytics, predictive analytics and things like auto flagging of unusual events. Doctors are used to analytics and algorithms and will embrace any good solution to these.

Similarly, machine learning/AI can play important role in things like reducing medical errors and postmortem of adverse events. These should be combined with training for human factors.

Continued medical education in its present form is very ineffective. Continuing medical education and remedial training/retraining etc need to be customized and focused to meet specific objectives.