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Book Review

‘The Doctor Crisis’ by Jack Cochran and Charles C. Kenney

Rare is the book that defines and successfully presents solutions to a problem as complex as that faced by most practicing physicians today. Despite doing their best to provide high-quality care, doctors struggle with various types of organizational, financial, and governmental red tape and oversight of their interactions with patients that are not just demoralizing but often result in worse outcomes.

This is what Jack Cochran and Charles Kenney refer to as “the doctor crisis” in their new book: a high degree of job dissatisfaction and burnout among US physicians, despite the importance of what they do and the high respect and material compensation they receive from society. The main cause, according to the authors, is that “[f]ar too often, physicians are prevented from putting their patients first — ahead of administrative hassles, finances, insurance company demands, regulations, and more.”

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Solving the problem, write Cochran and Kenney, will require “removing the many barriers between doctors and their patients. But it also means demanding that physicians step up and take stronger leadership roles on behalf of their patients.” In other words, doctors must not cede responsibility for fixing the health care system to others who fixate on short-term savings at the expense of long-term improvement of health outcomes — which also yields savings over time.

And to be clear: The authors are very much in favor of reducing health care spending. However, they make a very convincing argument that this needs to be led by physicians to minimize or prevent harm to patients’ health and to provider satisfaction.

This kind of physician leadership, the authors argue, is necessary at all levels, whether within individual practices or at the helm of health care organizations. “Too often, the question in health care for physicians is how many patients you can see today . . . [T]he better question is how many patients’ problems you can solve today — and this speaks to the role of physician as leader.”

Cochran and Kenny break their analysis into three sections. The first clearly lays out the problem.

The middle section reads like an extended case presentation that could easily be taught at a high-powered MBA program, with its abundant lessons in leadership, management, and critical thinking that will resonate with anyone desiring to improve their own leadership skills, regardless of where they work.

The last section provides many excellent suggestions for resolving the doctor crisis. These include preserving and enhancing physician careers, reducing administrative workload to allow physicians to do more of what they are uniquely qualified to do, and adopting “the best work anywhere as the standard everywhere” across the health care industry.

Cochran certainly writes from experience. Working as a surgeon with Kaiser Permanente in Colorado during the early 1990s, he witnessed how poorly conceived attempts to improve quality wound up angering patients and leading physicians to feel “that [doctors] were part of the problem.”

Because of this, he took on various leadership roles, rising through the ranks until he was elected executive medical director of the Colorado Permanente Medical Group in 1998. Before starting, Cochran went on an extended “listening tour” to better understand the problems faced by the group, and used what he learned to overhaul the organization’s culture. This enabled changes to be implemented that increased patient and physician satisfaction and resulted in better health outcomes.

Cochran and Kenney’s ability to present their ideas so clearly and cogently makes this an especially valuable book. Even though it specifically addresses change within the health care industry, because so many of the themes discussed — especially in the middle section of the book — have such broad potential applications, it will doubtless serve as a very useful guide for anyone seeking to lead and effect change within their own organization or industry.

Dennis Rosen is a pediatric pulmonologist who practices in Boston. His book “Vital Conversations: Improving Communication Between Doctors and Patients’’ will be published by Columbia University Press this summer.
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