The Healthcare Rules That Need To Be Broken

By Dr. Robert Pearl

The coronavirus pandemic is what academics would label a “strategic inflection point,” an

unforeseen event that causes the world to change dramatically and irrevocably. As a result of COVID-19, people everywhere have experienced major changes in the ways they conduct business, communicate, educate their children and plan for the future.

In the United States, perhaps no industry has been more affected by the pandemic than healthcare. From the earliest days of the outbreak to the recent rise of the Omicron strain, the virus has turned American medicine upside-down. As the New Year dawns, and as year three of the pandemic begins, a COVID-weary industry is aching for change.

Already, some of healthcare’s longest-standing “rules” – the unwritten norms and assumptions that govern the role of doctors, the experience of patients and the health of the country – are being tested and even broken. As one example, doctors had long subscribed to this belief: Excellent medical care can only be delivered in-person. That assumption quickly evaporated when Americans were forced to shelter in place and physicians had to close their offices in fear for their health. Within mere months, the use of telemedicine skyrocketed from 1% of all doctorpatient visits to nearly 70% while the hospital-at-home concept flourished as inpatient facilities became overwhelmed.

Once the rule against virtual medicine was broken, doctors were astonished at how much care they could deliver via smartphone or computer. Patients, meanwhile, were delighted by the convenience and speed of techpowered healthcare. The old rule suddenly felt outdated, disadvantageous and obsolete.

Of course, not all medical care can be provided virtually, but telemedicine is already starting to redefine the doctor-patient relationship. Instead of searching for the best specialist in the community or accepting a local referral, patients can be instantly connected with leading experts anywhere in the country.

The emergence and proliferation of telemedicine is just one example of the healthcare rule-breaking this column will explore over the next several months. In each installment, a new healthcare “rule” will be placed under the proverbial microscope and examined in detail.

This column will trace the origins of medicine’s most stubborn and outdated norms, often handed down from one generation of physicians to the next. It will shine a light on how to break the rules safely and smartly. Finally, this column will predict the winners and losers once new standards replace the old ways.

Half of all U.S. patients say that one large medical bill would force them to borrow money, sell their home or declare bankruptcy. The rules of healthcare economics must be broken, but how best to do so without compromising clinical quality?

One upcoming installment will venture inside America’s most prestigious medical schools, where admissions officers and faculty use absurd and outdated methods for selecting and training future doctors. The current rule goes something like this: The best doctors are those who excel at memorizing facts and taking tests. By the end of the article, readers will see how much time is wasted teaching the medical approaches of the past century rather than the skills physicians need in the twenty-first.

Another article in this series will challenge the longstanding assumption that doctors should be paid for each medical service (test, treatment, procedure) they provide, regardless of whether any of it helps the patient. Part of this analysis will examine a norm nearly every doctor is taught: Doctors must provide patients with the best medical care with no concern for what it costs. However, as readers will learn, “best care” is too often confused with “most care,” a fallacy that leads to redundant testing, needless treatments, preventable complications and soaring healthcare costs.

A century ago, patients feared a bad diagnosis because it meant having to endure physical pain and suffering. Today, a bad diagnosis often results in a different kind of suffering: financial ruin. Half of all U.S. patients say that one large medical bill would force them to borrow money, sell their home or declare bankruptcy. The rules of healthcare economics must be broken, but how best to do so without compromising clinical quality?

This series isn’t about breaking rules for the sake of irreverence. It’s about making American healthcare once again the best in the world. Long before the pandemic, American medicine was facing a dire cost and quality crisis. Now there is a financial imperative for reforming healthcare and a national desire for better clinical outcomes.

In 2021, the Commonwealth Fund once again ranked U.S. healthcare dead last among 11 of the world’s wealthiest nations. Despite spending twice as much on medical care as its international counterparts, the United States is home to the lowest life expectancy, highest infant- and maternal-mortality rates, and most preventable deaths per capita.

Americans are sick of healthcare as usual. It’s not that doctors aren’t working hard and trying their best. The problem is that they must follow outdated rules that stifle industry progress and yield embarrassing results. This series will leave like-minded readers eager for change and better equipped to break the rules of the past. Hopefully, they will find the courage, knowledge and inspiration needed to join together and lead the transformation process. That is the goal of this series.

Dr. Robert Pearl is the former CEO of The Permanente Medical Group (1999-2017), the nation’s largest medical group, and former president of The Mid-Atlantic Permanente Medical Group (2009-2017). In these roles he led 10,000 physicians, 38,000 staff and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members on the west and east coasts.

Named one of Modern Healthcare’s 50 most influential physician leaders, Pearl is an advocate for the power of integrated, prepaid, technologically advanced and physician-led healthcare delivery.

He is the author of “Mistreated: Why We think We’re Getting Good Healthcare—And Why We’re Usually Wrong,” a Washington Post bestseller that offers a roadmap for transforming American healthcare. His new book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients” is available now. All proceeds from these books go to Doctors Without Borders. For more information, visit robertpearlmd.com