A Starfish Approach to Population Health
Apr 4 2017 - Russell Kohl, MD, FAAFP
Physicians are going to have to change their mindset from individual health to population health. While this sentiment seems to be gaining in popularity as we face the transition from volume- to value-based payments, it overlooks a simple fact—primary care doctors have always done both. Populations are made up of individuals, so to better care for populations, we need to provide better care to individuals. I took an oath to do what was best for the patient in front of me, reverberates somewhere deep within the physician psyche. We cling to the story of the man on the beach flinging starfish back into the ocean, knowing that we are making a difference for “this one.” We recognize and celebrate that foundational tenet of medicine—the patient-physician relationship. However, physicians also realize that our challenge goes far beyond a single starfish. Effective population health is not a bulldozer trying to push groups of starfish across the beach. It’s the ability to identify which starfish will make it back to the ocean on their own, which will dry out and perish first and which can be tossed back by an assistant with a shorter throw. All of these decisions attempt to create optimal paths across the beach to effectively return the most starfish to the ocean. Population health recognizes that the entire team has a responsibility to help each one, but that the strong throw of the physician isn’t required for every starfish.
A turning point for many young physicians is when they realize they can’t save every patient; some turn cynical, some become more compassionate, but all are changed. That realization brought a different mindset to me—I don’t have to save them all. Many of the people I have cared for in my career didn’t require a physician—they required someone to listen, care and offer simple advice. The only glory to being outnumbered and overworked is when you begin to redefine the problem of trying to care for all and realize that the problem isn’t one of volume, it’s one of targeting. Who really needs to see me? That’s what population health aims to define. No change is required from the physician to move from personal care to population health, but instead there’s a change required to the population that sees the physician. As physicians, we simply have to keep up the long tossing of starfish, trusting that the starfish we are directed to are the ones that most need us and celebrating the success of our medical teammates with their equally important shorter throws.
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