This article in the NEJM gets to the kernel of one of the major problems in medicine: the increasing dysfunction of doctor-patient interaction fuelled — in part — by awful IT, and a systematic ability to admit that it is no longer possible to actually do what is required within the ‘allocated’ time. In many industries the goal is to match task with skill and, wherever possible, to reduce costs by allocating low skill tasks to those who cost less: ‘right person at the right time’. There is a variation of this in medicine: those charged with ‘support’ or undertaking ‘low skill tasks’ have just been removed, meaning all tasks — both high and low — are done by the same practitioner, but without any change in time allocated. This is akin to asking the pilot of a plane to serve you snacks and check you in, but keep the schedules the same.
In terms of medicine, that this happens is not so much a manifestation of a managerial view that places little value on ‘care’ (true), nor where business innovation (sic) is viewed as synonymous with sacking people (true), but a complete failure to understand their own business and what their own product is. In an ideal world businesses like this should go bust. The problems are when: they are run by the government; there are third party payers; or there is actively created informational asymmetry. Sometimes all three apply.