From childhood most of us remember the sage parental advice on how to deal with bullies--“sticks and stones can break my bones, but words can never hurt me”. Of course, we all know that words do hurt, maybe not physically, but they certainly take a toll on our psyche. These days in planning meetings at my own company, in articles I read on the web and at various tech industry conferences, I come across words and language that I know feel hurtful, or are at least disrespectful, to the health industry and the people who work there. I hear cavalier talk about the need to disrupt the healthcare industry. Some thought leaders even say we will creatively destruct the healthcare industry. Consumers armed with technology will rise up, they say, and disrupt everything about the current state of healthcare.
Now imagine for a minute that you are a hospital executive, a doctor, a nurse or other clinician and you hear people who work outside your industry talking about disrupting or destructing it. Imagine being told that consumers, patients, and tech companies will rise up and destroy your business. There you are doing the best you can to make it through each day keeping your hospital or practice economically sound, dealing with the barrage of patients at your door, staying one step ahead of ever-increasing rules, regulations and rising costs, while those who’ve never worked a day in your world tell you they are going to disrupt and/or destroy it. Even if there is a need to disrupt healthcare (and even many who work in the health industry might agree), nobody appreciates being told by some outsider that they know your business better than you do.
I don’t imagine my colleagues who work at Microsoft (or Google, or Apple, or Amazon) would appreciate being told by a hospital administrator or a doctor that they knew better how to run a tech company, or what ails the tech industry. Nor do I think that most patients and consumers can really appreciate the amazing complexity of our healthcare system or the unbelievable pressures under which it operates these days.
So, instead of casting stones maybe we should all try to work together. Can we not find a common ground—better health, lower costs, more efficient, consumer-centric models of prevention and care? Can we not mutually work on solving the current ails of our healthcare system? Can we not show mutual respect and have the humility to say that perhaps the professionals who work in healthcare know more than we do, or at least know a lot of things about their industry that we must know too if any of us hopes to disrupt what’s bad without destroying what’s good about healthcare?
So the next time you hear someone talk about disrupting or destructing healthcare, I hope you’ll have the common sense to remind them that perhaps they could choose better words, and most certainly they should approach the subject with a far greater sense of humility about that which they do not really know or understand.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
Dr. Bill, I will politely disagree with your thoughtful but off point article.
IMO, "disrupt" should be understood as agnostic, descriptive language. When it happens of course, if you are the disruptor, you will perceive it as "good". If you are the disruptee, you will see it as bad.
The U.S. healthcare system has begun transforming. From the times we've met and from your writings, I'm betting we both see this as very positive.
When the world is turning inside out, it doesn't do any favors to healthcare people to soft-pedal reality.
"Can we not find a common ground—better health, lower costs, more efficient, consumer-centric models of prevention and care? "
That language loses all the emotional impact. It doesn't get anyone's attention. It doesn't convey urgency or severity.
Dr. Eric Topol wrote the book 'The Creative Destruction of Medicine'. Modern Healthcare ranked Dr Topol the most influential physician executive in the United States.
Jonathan Bush, founder and CEO of athenahealth frequently calls for more disruption to the healthcare system.
The calls for destruction and disruption are coming from prominent insiders as well.
Thanks for your comment. I have met both Eric and Jonathan and have a great deal of respect for both of them. None-the-less, I'm just saying that all of us (in tech and healthcare) should show a bit more empathy to the other side. The opportunities to improve health and healthcare through the creative use of technology are enormous. But it surely wouldn't hurt to have a little more respect for the industry challenges faced by all parties.
Bill Crounse, MD
Urgency, yes. Carelessness, no. I just don't like the "bull in the china shop mentality" that I see all too often in the consumer vs. health industry or tech vs. healthcare industry battle. Let's show some respect for the healthcare professionals who have trained so long, and worked so hard to do what they do for all of us.
Bill Crounse, MD
Hi Dr. Crounse,
I couldn't agree more with your call for a compassionate approach to fixing healthcare, and an approach that values the expertise, contribution and empathy that physicians and clinicians exhibit every day.
I interpret the term 'disruption' in the Clayton Christiansen sense of the word to encompass both the disruption of care delivery models and current healthcare IT.
Does a blood pressure visit and consult always need to occur in a physicians office or it could happen with a Withings blood pressure cuff and a remote consult using a telehealth service?
Do all sleep studies need to occur in medical facilities, or can a subset of them occur at home?
Why do staff at the doctor's office need to measure my height and weight, and take my blood pressure when I have a years worth of self-generated data stored in the cloud?
I consider all of these to be examples of disruption and, perhaps even destruction of parts of the care delivery model and unfortunately it may have negative consequences for people that work in the healthcare industry just as telephone operators saw their industry disrupted and effectively destroyed.
Nearly every single EMR on the market today was built around the encounter, designed to capture billing information for an episodic care delivery model. As Christiansen has shown us, historically it has taken disruptive innovations to move to the next level, and in many cases, the old model was effectively destroyed.
I'm convinced that moving from fee-for-service to value based reimbursement will require a fundamental overhaul of the healthcare system that will, depending on your lens, appear to be destructive.
I sense that we are on the same page, and this is more about semantics. I agree that the words we choose matter and the challenge is selecting words that convey the magnitude of change the industry is facing without being insensitive and incendiary.
"The risk of insult is the price of clarity" -Roy H Williams
Thanks for your thoughtful comments. You and I are completely on the same page. My point wasn't to claim that healthcare or health IT don't have room for vast improvements. I am as frustrated as anyone with the high costs and often poor "customer service" the health industry delivers, I too am frustrated by often slow adoption of contemporary IT solutions (not only EMR but unified communications, customer relationship management, business intelligence, cloud, etc.). I too am unhappy with costly clinical systems that are poorly designed, lack interoperability, and force clinicians to become data entry clerks.
However, I also have a great deal of respect for people who work in the health industry. They are not techno-phobic Luddites. Physicians are some of the best and brightest people in the work force. They deserve respect and they need to be a part of the conversation. They hold the keys to the care that we will all need one day. The last thing we want to do is drive away smart people from the practice of medicine. We need to work together.
Your post has the advantage of creating discussion. Positive disruption is about redistributing the cards so that certain chronic deficiencies can be addressed. A big one is that consultations originally served for acute disease and in a world totally devoid of the technologies we now have and where the role of the patient was mostly undervalued . There are many others but to know them. I agree we all need to work together. That 360 degree view is what we strive for at Doctors 2.0 & You- June 5-6 in Paris. Will we see you and or your colleagues?
I always hated the word "disruption" - it's a bad marketing term run amok. Having been in in HIT, albeit on the device/infrastructure - not the EMR side - there's a common belief that you as a physician are merely in the way of a solid implementation of an EMR. After all, it was designed by someone who took a course in design, and *obviously* they know better than physicians.
In an ideal world, physicians and caregivers should be driving HIT, especially when it comes to point of care issues. A frequent issue at my large hospital was the attitude that doctors were "stupid" and those who brought up valid issues were "problematic" to healthcare leadership. And those who used the word "disrupt" always meant dealing with the "problematic" physicians by ostracizing them.
There's a lot of room for healthcare improvement in pretty much every discipline, but healthcare leadership tends to forget caregivers in the whole equation, making sweeping changes with virtually no input from them. And that needs to stop.
Interesting thoughts. "Disrupters" need to understand that health care is as much an art as it is pure science. Given this mix, it will always have messy, inefficient parts to it. Technocrats cannot fully grasp this idea, hence should ideally not be the "disrupters". How about if such "disrupters" emerge from within the practicing community - doctors, nurses, pharmacists and also patients? This can only happen if we are able to create a true free market in health care - like it is in IT or engineering and other industries. Are we willing to "foot the bill" to create such a disruption?