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Trust in Health Care
April 10, 2019

Building Trust Between the Government and Clinicians: Person to Person and Organization to Organization

Author Affiliations
  • 1Covered California, Sacramento, California
  • 2Institute for Healthcare Improvement, Boston, Massachusetts
  • 3American Medical Association, Chicago, Illinois
JAMA. 2019;321(18):1763-1764. doi:10.1001/jama.2019.4499

Building trust between clinicians and the government requires understanding, empathy, and humility. Those who set policy need to understand and empathize with the position of the clinicians whose lives they shape, and have the humility to realize that policies are not the only lever by which to drive quality and ensure appropriate use of resources. Equally, clinicians and the professional societies that represent them should strive to understand and empathize with the policy makers’ imperative to be responsible stewards of public resources, and also acknowledge the contribution some clinicians have made to the current health care financial crisis.

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    3 Comments for this article
    The Value of Shadowing
    Paul De Chant, MD, MBA | IBM Watson Health
    Trust has been steadily eroding across much of society. Where we can establish and strengthen trust we can solve problems much more quickly and effectively. The level of cynicism on both sides will be a challenge to overcome.
    I strongly support the recommendation that clinicians and policy makers spend time in each other’s workplaces. Otherwise known as “shadowing”, it is a far more effective way to understand the impact of regulations than reading reports and reviewing metrics with a committee in a conference room.

    I have seen shadowing lead to significant changes in administrators’ sense of urgency
    and commitment to fixing problems. Such urgency and commitment to change is desperately needed today in healthcare.
    CONFLICT OF INTEREST: My work involves coaching leaders to change management systems and culture.
    Robert Cummings, MD | VA
    There can be little doubt that the expressed goals would be helpful to all. There is no doubt that American healthcare can be the most successful in the world if goals were aligned.

    In many/most regions of the country direct provision of healthcare is a cottage industry. The goals and expectations of providers vary considerably.

    The issue becomes that Washington has no insight into clinical practice nor operations. Additionally there are a variety of “vendors” who will go to extremes to bilk the system. The recently reported Medicare scams of
    greater than $1 billion serve as evidence.

    The existing government system has vagaries which do not work to the benefit of patients or providers. Bureaucracy reigns supreme dominated by those with no valued clinical operations knowledge or experience.

    Healthcare can be successful. But, divergent motivations and expectations must align. Does a dedicated, knowledgeable $250,000 primary care physician provide as much value to a patient as a $850,000 cardiologist? Has attention been focused on the millions of compensation dollars paid to executives of healthcare related organizations? A billion dollars to less than 50 individuals can underwrite a significant amount of healthcare.
    Shadowing Good but Face to Face Engagement Over Issues Also Important
    Edward Volpintesta, MD | Bethel Medical Group
    As a primary care physician, it would be interesting for government officials to ‘shadow’ doctors. But besides watching doctors deal with paperwork, it is impossible for them to understand the internal work they do listening to patients’ symptoms, examining them, and integrating it all into diagnoses and treatments.

    Shadowing cannot convey strain of telephone calls after hours or during the weekends; or the strain of dealing with difficult patients or the emotional needs of the elderly or of patients undergoing major social crises at home such a divorce or a child with a drug addiction. The list
    goes on and on.

    My preference is for physicians through their leadership organizations to meet with government officials, engage them, and express the pressing need to solve the problems facing us face-to-face.

    This can be done locally through our state and county medical societies.