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Carey Kriz: Rebuilding the Past as the Future of Healthcare Services

I am pleased to introduce well-known healthcare expert, Carey Kriz, as he shares his thoughts on rebuilding the past as the future of healthcare services. The front end of the healthcare system is one of the most precious assets we have in our country. Often undervalued and overlooked in a time of intense technologies and discovery, the primary care provider has been the historic army we used to challenge individual disease -- and the conduit for relationships in the overall maze of our health community. Unfortunately, primary care is a long way from the artificial reality of television and the movies, with declining numbers and really bad morale hitting the field in record numbers.How do we rebuild it? How can we extend and enhance its mission? And what role will technology play in its future? Read the full article “A DISAPPEARING SPECIES” and add your comments and ideas to this web site. It’s time for all of us to become the authors of the next chapter of the health industry. A DISAPPEARING SPECIESby Carey KrizIn 2008 the World Health Organization published a report, “Primary Healthcare, Now More Than Ever”, that was as important a wakeup call on our industry as anything I have ever read. Like most good research reports, and discoveries that are too subtle to gain the attention of the press, this report was not featured on Oprah or the broadcast news programs. In fact, it went unnoticed by the average person in the U.S. But it should not have been ignored, and here’s why. We have a crisis brewing in our global healthcare delivery system that has the potential to stop and more generally undermine the growth of the emerging economies and the incredible progress they have made over the past twenty years. Building factories for production, new roads to move goods, and teaching people how to show up for industrialized work, it turns out, is only a small part of the story. Sick people, as you probably understand, are not as productive as healthy ones and the almost three billion people living in India and China have real issues in how they access healthcare. In the large rural populations of these emerging economies getting access to healthcare is not even close to a right or commercial choice -- or the exact opposite of the average view of healthcare held by the average American. And don’t think of big hospitals or diagnostic clinics as the answer for these hard to reach and underserved patient populations. While they are often a requirement for performing the life saving heroics we have come to expect for complicated mechanical issues in our body, building a hospital in the middle of a remote town and village when a large number of people are dying from infectious and communicable disease is not the best use of these developing country’s assets. And don’t expect our for-profit healthcare industries to step up to the plate. Making money off poor people is not easy, and nearly impossible in countries where the average annual health expenditures is less than the cost of a hotel room in New York City on an average week day. The net is that we often have a tendency to equate good healthcare with buildings and physical locations, which I believe that is the wrong way to frame the debate -- and it will definitely not be the final solution to the global health challenges facing these emerging countries. Unfortunately this focus on the “bricks and mortars” of the business is happening everywhere and may even escalate based on the current push to build more infrastructure as part of our financial rescue package.I think this is shortsighted and here’s why. I live in Annapolis, a small town in Maryland. Over the past few years I have been watching my community leaders invest seemingly limitless amounts of money into our local hospital, turning what was once a quaint historic structure into something that resembles a new age industrial park. And while clearing land, bringing in the bulldozers and hiring construction crews may give the illusion of an organized system of healthcare delivery, the reality is often quite different. While piling an increasing amount of money into the physical plants of our healthcare industry may seem like a great way to keep people well it can easily miss the mark when it is done in isolation -- and without a master plan for how the collective health resources of the community connect. What went wrong? The problem I believe is ultimately a question of focus, people and relationships. I believe that healthcare is and will always be about the relationship of an individual to their own body and to knowledge that can help them either improve the body’s performance or to overcome the challenges of a disease or injury. And in almost all cases the basic transactions of health can be managed through extremely simply connections of people to people and people to data. Health is ultimately about communications and community, and should not be solely defined by the impressive structures of our hospitals, the commercial interests of the marketplace, or even the increasing fragmentation of healthcare professionals. So why is the WHO report so important to those of us living in the U.S.? We are not, after all, grounded in one of these emerging economies the WHO so clearly described as having the primary care issue. Or maybe we are. Because while getting access to a physician may be tough in rural Pakistan, it is also becoming a challenge for almost everyone I know. We have gradually, but with increasing speed, continued the shift away from a focus on patient empowerment to the growth needs of the “systems” of healthcare. And we have forgotten that the basic quest should be to understand and optimize individual health. Yes, I know and appreciate the obvious facts/benefits of and about the U.S. healthcare system. We have a much higher life expectancy than say someone living in Swaziland. We also have the ability to at least get access to some of the most advanced life saving approaches (read that as new drugs and treatments). But we also have something in common with the emerging economies described in the WHO report that is growing and threatens the stability of our healthcare system -- the dramatic decline and attempts to basically wipe out our primary care providers. Losing Montgomery-Wards (the old retail giant) or even Arthur Anderson (the old accounting giant) was not ultimately a show stopper for any of us. They were simply one of the many plug compatible players in the ecosystem of our economy. But what would happen if you eliminated all accountants in our country -- or worse renamed, demoralized and eventually marginalized them to the point where they simply stopped showing up for work? The analog is starting to happen to us today, and in slow and often torturous ways. The target this time is the old-style, and some would say, outdated family doctor.When my parents (and mine would have been in their 90’s were they alive today) thought of healthcare they did not think of their local hospital as the part of their story. During the early years of their lives, the hospital was only a tiny bit better than their counterparts of the 19th century, which were basically places you went to die. The hospital was definitely not someplace that you wanted to visit; unless that visit was for giving birth to a baby or seeing some else that you knew was ill. For my parents healthcare was about the long-standing relationship they had with their family doctor, who was a combination of a medical encyclopedia, therapist, and a trusted friend. This doctor was as much a part of their family as I would later become. I eventually came to know and respect their sometimes paternalistic but always caring, emotional connection with me. But forget about this relationship in the 21st century. In our “modern” environment the family physician and more generally the whole concept of the Primary Healthcare Provider has become a maze of corporate relationships. For my kids, and almost every other kid that I know, there is no such thing as a family physician. In their world healthcare has become a chaotic blend of energy drinks and pills, with the notion of doctor relegated to times when they are really sick. Know the name of your physician, or even that they know who you are? Then you live in a place that is rapidly becoming extinct in our new era of Minute Clinics, the Internet, and healthcare as a business. How do we fix this mess of uncoordinated care, mixed agendas, too much information and not enough knowledge? My sense, as I mentioned earlier, is that it will come through a new world of connections, with the driving force being technology and a renewed sense of community. Any ideas on how we build it? How real is the projected decline of primary health providers? What impact do you think this impending decrease of physicians and nurses will have on our health system?How important are hospitals in our health delivery network? Is the evolving model of the hospital keeping track with the pace of our discovery?Would love to get your comments… Thanks!

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5 Comments.


  1. I thank Carey Kriz for opening up this important debate. Words have a way of blocking thought –and Kriz is correct to call the problems we face in health care by their right name –we do not have a health care system as such but a set of broken fragments–that fail too many people–particularly the 46 million uninsured and the 50% of people who go bankrupt in the US as a result of being unable to afford their health care costs.We cannot bring back the age of the family doctor and wax nostalgic about the day when he or she took time from their surgeries to make home visits. But we can and need to think seriously about the kind of trade offs we need to make as a society and rein in our temptations to let the free market always decide how those trade offs should be made. For example, we know there are tremendous cost savings to be had by focusing on prevention, but where are the incentives in the system to pay the costs of the nutritionists, exercise specialists and educators to help people adopt healthy life styles? It is far too attractive for doctors to specialize in one lucrative area (say cosmetic surgery) than to repair a cleft palate of a poor person. If you caught the 60 minutes segment the other day you would have seen thousands of people lining up for needed dental work in a hired hall filled with volunteer dentists because they could not afford basic dental work. Technology can also help with cost savings–expensive medical monitoring that can require hospitalization can be done from the home–we need to think through how we can use the increasing technical capacities of the personal computer to cut costs. But where can we host these kinds of discussions–how do we do so without vested interests getting in the way of re-thinking and reimagining what health care looks like when as President Obama has said healthcare in an advanced 21st century society when it is a right and not a privilege in an age of literally astounding breakthroughs in all areas of medical science. Thanks Carey for getting us off to a great start–now lets all join in on line and off, town hall meeting and dinner table to discuss where this all goes.

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  2. Nurses can be part of the solution. Nurse practitioners already help to fill in the gap at physicians’ offices as well as in the acute care setting. At the large teaching hospital where I bring nursing students for training, nurse practitioners cover the unit.They have their own practices in the community as well under the guidance of a physician. In the global setting with pc based video conferencing with satellite transmission, they could assess multiple patients while consulting a physician from long distance. They need better access to advanced training so they could assume this role. Again, this could be accomplished through technology with distance learning built into the curriculum.

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  3. Unfortunately the WHO report was ignored and we still suffer from crippling health care in this country. Thank you for opening up this debate, bringing much needed attention to this issue.

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  4. cool post.it’s interesting.

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  5. I think that hospital is is very important for health caret, my mother is working there and she’s telling me what they work there.Now this virus H1N1 getting started in my country and a lot people are in hospital…

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