Not your father's health care - Next! - the health care industry will likely change as much as Las Vegas has

Physician Executive, Sept-Oct, 1999 by Joe Flower

Here's the way to bet: Sit down with a notepad and write down all your most basic thoughts, beliefs, assumptions, and expectations about health care. What is "health care?" How do people get it? What is a doctor? Where does a doctor work? What does a doctor do all day? What's a hospital? Who's in charge of it? What's it for? Who pays for all this? You will probably be able to cover pages, if you take the time to rummage around and think about it.

Now go down the page, look at each fact, belief, assumption, and expectation, and turn it upside down or inside out. Imagine that it is somehow no longer true, much the way Einstein invented a new geometry simply by assuming that parallel lines do. after all, meet somewhere. What if doctors are not highly paid professionals? What if they are not the final arbiters of medical questions? What if hospitals are not centralized, multi-function facilities housed in large structures? What if surgery is not a major and common therapeutic tool? Ask yourself, for each one, "How could that be? What would that look like? How would it affect other things?"

If you carry out this exercise, you may well come closer to the future of health care than the pontifications of any pundit, For good and for ill, it is likely that health care is entering an era of extreme turbulence. It is likely that everything you believe to be true about health care will become false--or one of only many alternative truths--within ten years. You may be working for a type of organization that does not now exist, in a job that has not been invented, conducting your daily business through tools that we can barely imagine.

Why are you in health care?

Now add to your list one more question: Why are you here? Why are you in health care?

That alone will not change. If you, like many, came to health care for more than money, or power, or any of the other basic rewards, if you came because you wanted to make a difference in people's lives, that purpose will still be there. In fact, the new technologies and ways of doing business may well offer more opportunities than ever before to prevent suffering, offer health and healing, bring good strong babies into the beginning of life, and help people toward a good death at the end of it.

The showgirls still kick high in Vegas, and the dealers keep their hands in sight at all times. All the ferocious, confusing changes feed the abiding human drive for excitement and dazzle. In health care, the drive we feed is different--the drive for health and healing--but the pace of change will be even faster, the effects even more dazzling, the decade even more exciting. Think of it as a heart test--in health care in the 2000's, you'll know that your ticker still works.

Joe Flower is Prindpal of The Change Project, in Larkspur, California. He has written about change in health care for over a decade. Author of hundreds of articles, he is a Contributing Editor for the Healthcare Forum Journal and New Scientist, a system host of The Well Computer Conference, and a faculty member of HeatlhOnline. If any of the ideas presented in this column resonate with your experience, drop Joe a line at The Physician Executive, or at bbear@well.com on the Internet.