Does Recent UK Physicians’ Strike Carry an Important Message for the US?

---Anna Shepherd, Health & Personal Finance Professional - Cambria Health Advisory Professionals

For this blog, I generally try to find news that raises prescient questions about healthcare and economics in our current climate. This article (link below) goes a little outside of that but I find it important nonetheless to keep in back of my mind as a guidepost of sorts. It details a recent strike effort by General Practitioner’s in England’s National Health Services (NHS) over a pension dispute with the government. The government has requested that the doctors contribute more to their pension plans as well as raise the retirement age in order to ease the burden on other health care workers such as nurses or porters (patient transporter). The story reports that this strike was small, affecting about 24% of practices, but was still effective due to the tumult the system saw from canceled surgeries, closed clinics and rescheduled appointments. What I find interesting about this article is the insight into NHS functions, and how we’ve experienced similar issues in the US, and what it meant to the patients. http://www.dailymail.co.uk/news/article-2162242/Doctors-strike-affects-10-patients.html

This illustrates a key inefficiency in the NHS: the doctors are not beholden to the consumers. The chairman of the doctor’s union even used the phrase ‘the fight is with the government’, implying that they are not trying to hurt their patients. But who gets hurt when their scheduled surgery, (an appointment that is often difficult to come by in the first place) has to be rescheduled? The power of the purse is in full display in this instance. In the US, we’ve created a society that engenders pride in the success of doctors. We want our doctors to be highly competent, well compensated, and esteemed for their efforts. Bumping them down a peg to the status of ‘cog in the machine’ will certainly not lead to better outcomes. 

We have had similar issues in the US with government employees. You may recall the air traffic controller strike of the 1980’s or rows in individual states over pay and pensions, such as the recent recall election of Scott Walker in Wisconsin. The very idea of public employee unions has been in dispute even going back to the FDR administration. In a letter to a Federal union he wrote,

• “All Government employees should realize that the process of collective bargaining, as usually understood, cannot be transplanted into the public service. It has its distinct and insurmountable limitations when applied to public personnel management. The very nature and purposes of Government make it impossible for administrative officials to represent fully or to bind the employer in mutual discussions with Government employee organizations.”

This seems pertinent still today, given that after the recent Supreme Court decision upholding the ACA, several commentators in the healthcare industry have been predicting the eventual unionization of doctors; if Britain serves as an example, it is not one we should be clamoring to follow. Here’s a link to a very good article on the effects doctors may see in the coming months: (http://news.heartland.org/newspaper-article/obamacare-expected-increase-loss-doctor-owned-practices)

Now to bring the focus back to the most important driver of healthcare: the patient. A problem lingers with the whole premise of having a doctor’s union. I can only ask the question---- because after much thought, I realized that my solutions got very murky, political, emotional, and ultimately led to naught (at least for the purposes of this blog):

What do you do when your doctor is in a union and you no longer trust him/her to put your best interests first? It seems far-fetched for the United States, given the culture I described above, but it’s all too real for thousands of patients in Britain right now.

Read more at the American Presidency Project: Franklin D. Roosevelt: Letter on the Resolution of Federation of Federal Employees Against Strikes in Federal Service   http://www.presidency.ucsb.edu/ws/index.php?pid=15445#ixzz1zbinKpWE

Giving People the Power to Make Choices is a Tricky Proposition

Terri Bernacchi, PharmD, MBA
Health Advisory Professionals
England’s infamous health care system is always undergoing flux and scrutiny as leaders try to find new and better ways to save money, provide care, and meet expectations for quality and outcomes. The concept of “shared decision making” and patient empowerment is proving to be difficult there, too, however, as evidenced by a recent article published in the British Medical Journal. The British government has publicized its plans to introduce wider choice and shared decision making within the NHS, but they are finding that it may be challenging to implement based on several factors, some of them unforeseen.

For example, evidence suggests that while patients like the idea of a choice of physician and being involved in personal health decision making, the clinicians are not necessarily warm to the idea. Changing these attitudes in the provider community requires changing entrenched styles and operating beliefs within the professional community itself.

Moreover, while the UK National Health System already provides patients with information on quality, safety and outcomes and promises to publish more detailed information in the future, the evidence suggests the patients are not using it! And it appears that physicians don’t really understand what the patients themselves want regarding information and decision making.

While there are decision aids for many diseases and conditions already in place, the NHS and its practitioners continue to struggle with how to embed these tools, and how to shift attitudes and skills so that shared decision making will be put into more routine practice.

How can this information from the NHS help those of us in the United States, where the idea that a patient would not have choices is a foreign, even hostile concept? 2010's health care reform has been unpopular with a large percentage of Americans. But the reality that every individual’s inevitable need for health care looms in front of all of us and the lessons learned by the NHS are helpful. In order to create a fully empowered (and accountable) patient in the US, we need to make sure that:  

• the patient understands the information that should be considered in making decisions and the consequences of each option
• the physician and other supporting clinicians are encouraged to work with the empowered patient which may mean reforming paternalistic patterns of communication and care
• the financial system that is the underpinning for the empowered patient must support the process of “Shared Decision Making”, without creating disincentives to the physician, the patient, or other stakeholders like family members.

Read more: http://www.4ni.co.uk/northern_ireland_news.asp?id=117833

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets. The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.