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e-Patient Dave and the New Excellence: Consumerism Comes to the Medical Market

What follows is a special article written by e-Patient Dave deBronkart. I’m glad to share Dave’s thinking in this space and to welcome him to our upcoming St. Luke’s Health System Summit as a featured speaker.

It’s a time of great challenge for everyone in medicine, and challenges bring chances to excel in new ways. The rules are changing. Here’s why I think the change is real and how we can retool for the future ahead.

I preface my remarks by saying I’m alive because of the best of medicine. Diagnosed incidentally in 2007 with stage IV renal cell carcinoma, I confronted my mortality, and placed myself in the hands of the best clinicians I could find. I experienced great care, mediocre care, and shortfalls, but most of all I experienced successful care. At times I reflect on all the years of training and clinical experience my care team brought to my bedside and the operating room, and I am grateful. Grateful.

But the world in which those professionals operate is changing forever, due to at least four factors:

  • New money rules
  • EMRs, with their substantial challenges and possibilities
  • The Internet and e-health, putting information and tools in families’ hands
  • Consumers’ increasing awareness of who’s best, what things cost, and their own ability to step up and get engaged

There may be other industries where so much has changed at once, but I don’t know of them. I myself lived through dramatic restructuring of my industry 30 years ago – typesetting – when desktop publishing put fonts and tools in consumer hands.

Today, my industry lives in your computer, perhaps even in your phone. We who excelled at the old game couldn’t imagine such change, but reality is reality, and when technology democratizes, change is real. Some ignored it at their peril – but some understood it, and got a leg up on the laggards.

But typesetting is not medicine. None of the factors confronting medicine alters the most important element: the medical excellence that saved my life. Yet they do change the context – everything about the context – in which that excellence plays out.

I’m an e-patient: equipped, enabled, empowered, engaged. I’m no clinician, but I do everything in my power to help them, to play an active role in my own care, and even in the design of care. In my work with St. Luke’s next month, as an activated and grateful patient who lived through his own industry’s change, I’ll share my views on how each factor affects the future of medicine:

The money rules, what providers get paid for, are changing. Fee for service is fading, and keeping people healthy is emerging. I don’t need to explain how great that is, in the eyes of patients. But we want our best docs to be protected. When the rules change, strange things can happen; there will be turbulence, and alert, strong leadership is required, with the agility to adapt as the months go by.

EMRs, with all their workflow challenges, are vitally important to achieving the best of what’s possible. (My own hospital has had a home-grown EMR since the late ‘90s.) I’m not happy with the usability of today’s systems, but we have to start with what we can get and demand that it improve.

In my view, EMR adoption is not just to shove technology down your throats; as I’ve blogged, nobody can perform to the top of their training if they don’t have the relevant information. Plus, as other industries know, you can’t improve what you can’t measure. Computerizing our records is an essential step.

The Internet has become a fundamental part of most people’s lives, and that means it’s come to medicine. It’s widely said that there are more Google searches for health every day than there are doctor visits. The good news is, this is a clear sign that people want to understand their health. They want to engage and be informed. Providers who welcome this – who teach, coach, and encourage – will be preferred over those who roll their eyes.

And smart patient communities can be genuine partners, bringing real value to overloaded clinicians. As I said in testimony one day in Washington, “The solution is not to restrict and constrain. Empower the people: enable, and train.”

eHealth, characterized by gadgets, self-monitoring, and useful websites that help people track their conditions. It’s still early days in this area, but it’s happening. It tickles me that my own doctor can’t see the slick charts I have ­– far sexier than his – when he looks at my record in his system. That will come, as the big-iron systems realize they’d better open up or look stupid.

Consumerism, a scary word, because on the surface it sounds like medicine’s getting dumbed down, like buying a TV at Best Buy. Except. The major reasons I trust Best Buy are that their online convenience is awesome, their prices are clear, and I can take things back if I don’t like them.

I do want my docs to have convenience features – online appointments, online records – but when I need surgery, I want excellence, not a return policy. I want good infection rates and I want someone who listens to my needs and lets me help. Not just for my generation. For my mom and my daughter … and someday my grandchild.

Consumerism is a threat if you’re worried about how you rank. But if you want to be rewarded for being better than the rest, there’s nothing better than readily accessible quality data and great satisfaction scores.

All this might feel like a threat, and I’ll say from experience, when your industry shakes up, it does feel like that. It’s times like this when lean methodology advisers tell us to remember True North: the purpose of the work and why you chose it.

As I’ve gotten to know clinicians in my travels, time after time I’ve been inspired to hear why people went into medicine: to apply their way-above-average minds and hearts to work that’s beyond most people’s capacity, and perhaps save a few lives. A changing environment doesn’t change that ground truth.

I’m thrilled to be joining your leadership for the St. Luke’s Health System Summit next month. It will be an honor to work with the people at St. Luke’s. Thanks to Dr. Pate for inviting me, and to all those who’ve worked in preparation.


  • Great post.

    We, as providers, need not be scared of consumerism, but need to embrace it. Atul Gawande, the wonderful surgeon and writer, offered that health care can learn a lot from the retail restaurant industry, and I certainly agree. See his “Big Med” article at

    Cookie-cutter medicine is the fear, but look at where we are at presently. We have to do better. I’m not scared of doing something more convenient, more satisfying, equally high quality, and more cost-effective for the patient. Neither should our colleagues be.

  • Hi, Dave.

    Thanks for your comment. I am very excited. I heard Dave speak at the Leadership Institute and was mesmerized. His ideas, learnings, and perspective will help take us to the next level. And I’m very excited for the 350 administrative and physician leaders and board members who will have a chance to learn from him.

    We will videotape his presentation and post to the blog for all to enjoy and learn from.

    Thanks for all the support and encouragement you have provided us along our journey to transforming health care. I owe you a coffee next time you’re here!

  • Ben, I thank you deeply for drawing my attention to that Gawande column. I urge everyone interested in transforming hospitals to read it twice.

    Sometimes I think I miss more Gawande columns than I should because he makes me think about giving up writing, the same way Annie Liebovitz makes me shy away from expensive cameras. :)

    I had to laugh at this explanation of fee for service:

    “Historically, doctors have been paid for services, not results. In the eighteenth century B.C., Hammurabi’s code instructed that a surgeon be paid ten shekels of silver every time he performed a procedure for a patrician — opening an abscess or treating a cataract with his bronze lancet. It also instructed that if the patient should die or lose an eye, the surgeon’s hands be cut off. Apparently, the Mesopotamian surgeons’ lobby got this results clause dropped.”


  • Hi, Ms. Serio.

    I am sorry, the event is an invitation-only event due to space constraints and the fact that we already have 350 people planning to attend this official St. Luke’s event for leaders and board members.

    The good news is that as a part of our community benefit, we are filming Summit sessions and will post highlights to my blog soon afterward. Stay tuned to the blog!

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