The Doctor Crisis

May 12, 2014
Cochran, executive director of the Permanente Federation, and former Boston Globe editor Kenney (Transforming Health Care) argue that while health care reform talk may be loudest among politicians in Washington, doctors have a pivotal role to play in improving medical "access, quality and affordability" by solving the "crisis" of burned out and pessimist members in their own ranks. The authors point out examples of potential solutions, using the Oct. 9, 2001 separation of conjoined twins Lexi and Sydney Stark as an illustration of "American medicine at its best." Cochran used his leadership at Kaiser Permanente in Colorado to lay out a new "mission" for the medical field: to support primary physicians' careers, better the "patient care experience," and streamline the care process. At the heart of the transformation is what Cochran calls the "Learning Coalition": "physicians as healer-leader-partner" looking for "best practices" and applying them at their hospitals and offices. The authors also address issues of liability burdens, transparency in healthcare, payment reform, and bringing health care to the workplace and schools. They cheerlead for a nation that supports its doctors "so they can do their best for patients," and for physicians to set the stage for real health care change.

May 1, 2014
The executive director of the Permanente Foundation argues that physicians are the key to creating a health care system that is patient-centered, safe, equitable, accessible and affordable.With the assistance of former Boston Globe journalist Kenney (Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience, 2010), Cochran draws on his years as president and chairman of the board of the Kaiser Permanente Medical Group in Colorado, where he developed and tested many of the ideas presented here. When he took over, the morale among physicians was low, and turnover was high; the group was losing members. Working with a team-he had not been a manager before and was learning on the job-Cochran set specific priorities for the group: preserving and enhancing physicians' careers, optimizing the patient care experience and streamlining the care process. In detailing the obstacles and solutions, he makes clear that building a culture of collegiality and teamwork was essential. Nurses and clinical pharmacists were brought into partnerships with physicians, giving them greater responsibilities and career opportunities and freeing physicians to do the kind of work that only they could do. The author is especially proud of the methods he developed to rapidly set up a massive electronic health record system that increased the efficiency of patient care. Cochran calls on doctors, who have been trained to be healers, to expand their mission and take on a combination role of healer/leader/partner, and he insists that health care be a "learning industry." Talented people from all disciplines-clinicians, researchers, the pharmaceutical industry, etc.-must work together and learn from each other to seek out the best practices and apply them to provide the best patient care.While the book gives outsiders a peek into the inner workings of a large medical group, its message is directed primarily at members of the medical profession, more specifically, to those in management positions.

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May 1, 2014
Many doctors are feeling pessimistic about the future of the medical profession. For them, doctoring seems harder and less fulfilling than ever before. Cochran, a physician-executive with the Kaiser Permanente medical organization, and Kenney, a health care writer, consider the causes of physician frustration and futility. As they see it, the contemporary doctor crisis exists because physicians cannot always put care of their patients first. Bureaucracy, a fear of liability, reduced payments, and excessive regulations are some of the many factors that prohibit doctors from placing the patients' needs above all else. Part of the remedy is for physicians to assume active leadership roles. Doctors are positioned to play the major part in any ideal health care system that is patient-centered, easily accessed, fair, safe, affordable, efficient, high-quality, and innovative. Much of the book chronicles Cochran's role in changing the culture and reshaping the medical group of Kaiser Permanente in Colorado. The Doctor Crisis asserts that health care will only improve when the careers of physicians are fortified and their roles as leaders expanded.(Reprinted with permission of Booklist, copyright 2014, American Library Association.)