The core characteristics of what it means to be a good physician or a good medical group will never change, according to Larry Casalino, Chief of the Division of Health Policy and Economics at Weill Cornell. At the same time, those characteristics alone are no longer sufficient. Casalino sat down with NEJM Catalyst’s Tom Lee to discuss the need for both the traditional visit-based view of a physician and for incorporating ways to make our population healthier. Read or listen to the interview below.
Tom Lee: This is Tom Lee for NEJM Catalyst. Today I’m speaking with Larry Casalino of Weill Cornell Medical College, where he’s Chief of the Division of Health Policy and Economics in the Department of Healthcare Policy and Research. Besides being a real expert in health policy, he also has the experience of having been a primary care physician leading a group in the Half Moon Bay area of California. So he has both academic as well as on-the-grounds experience with the topics we’re discussing today.
Larry, if you were coming out of medical school today, I know you would be coming out wanting to be a good physician. You’d want your medical group to be a good medical group. What would it mean in this day and age if you were coming out today, to be a good doctor, to be a leader of a good medical group?
Larry Casalino: I think the core characteristics of what it means to be a good physician will never change, and that means taking responsibility for the patient, really feeling that you are responsible for what happens to your patient, and not pointing fingers at someone else if something goes wrong. I think it’s important to develop and to maintain the necessary skills, so you need to be technically good as a physician and stay that way. And it’s critical, I think, to listen to people, and to be empathetic, and to really care about them.
So I think those have always been the core characteristics of a good physician, a good professional, and those will always be the case. But although I think they’re necessary, I think more is now needed. I don’t think that is sufficient anymore, to be a good physician, or if you’re a medical group, to have physicians like that — not sufficient to make you a good medical group.
I’ll elaborate on that by saying that I think the traditional view of being a physician is, I take care of whatever patient happens to show up in front of me while they’re in front of me, and if I do a good job, I’m a good physician, and if I’m a really good physician I actually get in touch with them with their test results and things like that — talk to them on the phone, or whatever.
So I think that kind of traditional visit-based, “individual patient view of being a physician” is still necessary, but isn’t sufficient. And what we need now, and I’m not saying anything I think people don’t know, is that we need also to think about not just, what do I do with whatever patient happens to show up in front of me while they’re in front of me, but what does my organization do for all the patients for whom we’re responsible, and not just when they happen to show up, but proactively.
So, what do we do to step back and think about, what are the best ways that we can make our population of patients healthier? What do we need to do to do that? And I think that nowadays, to really feel like I’m a really good physician, and my medical group or my hospital or whatever is a really good organization, we need to have both the traditional ways of being a physician, and this new population health/organized-process view of what needs to be done.
Lee: And I would add that in this day and age, it’s not just being excellent as an individual. It’s also conveying to the patient that we are all working together as a team because patients are scared about whether or not teamwork is going on because they know how complicated care is.
Casalino: Let me just add to that, Tom, if you don’t mind. I agree that no matter how excellent you are individually, it just isn’t enough anymore. I mean, we used to think during training and practice — certainly this was the case in the world I lived in — that there were things that went wrong, that they just went wrong, that patients just got blood clots after surgery, people got infections in central lines, and there were a lot of things that happened to people that we almost thought were just kind of like acts of God or this is just the way medical care is, you can’t always have things work out like you’d like. Or you’d have patients with serious chronic illnesses that wouldn’t follow your instructions, wouldn’t take medications properly, whatever, and that was kind of their fault, but I’m a really good physician because technically I’m really good.
And I think now, that’s not enough. I think we need to realize that any bad things that happen to patients — we need to look at why they happened and what can we do, as you say, as a team, to make it so they don’t happen at all, as far as we can do things. So, I think that does require a somewhat different view of what it means to be a physician, and what it means to be a medical group or hospital, really.
Lee: Well, Larry, I know that you can synthesize what it means to be old-school in the new era, as well as anyone can. So I want to thank you for your time today, and I know that we’ll be coming back to you for commentary and recommendations on this issue in the years ahead. Thanks very much.
Casalino: Thanks, Tom. It’s always a pleasure speaking with you.