WHAT INSPIRED THE CREATION OF RSHC?
Ren Specialty Health Care (RSHC) began from one doctor's desire to bring back the "personal physician." In today's world, the concept is almost absurd. I suppose that's understandable. After all, the closest my generation came to seeing a traditional doctor was by watching "Field of Dreams." Even then, one could hardly see the doctor because of sobbing to the point of clinical dehydration. I mean, I don't know that personally...that's just what someone told me once. Seriously though, drink a glass of water and check it out:
Despite the disappearance of doctors carrying little black bags, multiple studies* prove that patients overwhelmingly prefer the idea of a personal physician compared to their current primary practice. Yet, no one really believes the traditional housecall doctor exists anymore (including most doctors). It's almost as if personal physicians picked up their supplies and wandered into the wilderness, joining the ranks of Loch Ness, Bigfoot, and the Chupacabra.
Modern medical care has successfully turned patients and doctors into indentured servants. It's true that some doctors love the disease more than the patient; they tend to become specialists and/or surgeons. To emphasize, there's nothing morally wrong with doctors who prefer their quality time be spent with scalpels or microscopes. In fact, modern corporate medicine encourages and pays highly for such predilections.
However, if you're a physician who loves people more than the disease (and there are many of us), you're in trouble. Why? Because your heart leads you into primary care, one of the most needed - yet most understaffed and underfunded - ways to practice medicine in our country. The YouTube personality, ZDoggMD captures this idea perfectly:
It's nearly impossible to resolve the conflicts between business demands, physician capabilities, and patient needs. The advances of modern medicine (e.g. electronic medical records) have resulted in powerful and useful ways to diagnose and cure. Yet, they also created a vicious cycle that goes something like this:
- First, businesses want to buy the latest technologies while making profits. Therefore, physicians are pressured to increase their "productivity," usually by meeting a patient quota while also meeting enough documentation criteria to bill at the highest level. This means:
- patients are usually limited to a 15 minute office visit;
- hospital patients are lucky to get more than ten minutes with the rounding physician;
- physicians spend hours documenting;
- and management must hire a special coder to identify documents needing minor additions to meet "payment criteria" for certain diagnoses.
- Second, today's perceived medical culture is largely due to massive corporate advertising campaigns. A combination of multi-state hospital conglomerates; Big Pharma; technology companies; and insurance agencies conjoin to sell certain ideas, which often sound like promises (except for all the fine print). Examples of these often inaccurate - yet widely accepted - advertisements include:
- Improved non-generic drugs;
- increased safety of "intelligent" hospitals with integrated information systems;
- miraculous cancer cure rates in Oncology-specific hospitals;
- the idea that "scientific advances" are honest and reputable;
- the implication we deserve to live into our 90's;
- and the suggestion that new and enhanced technology results in improved outcomes.
- Since advertising campaigns fail to discuss their product's associated research, patients naturally develop high expectations for today's medicine. They are taught - through no fault of their own - an unrealistic and inflated impression of what's possible from both modern medicine and their physicians
- Increased patient demands fuel competition between hospitals/clinics, driving them to improve patient satisfaction while also purchasing the latest technological gadgets. Additionally, the more hospitals can document they meet certain protocols for certain conditions (e.g. strokes, heart attacks, pneumonia), the more prestige, funding, and grants they receive. This leads to a series of management problems:
- "Performance improvement" choices are made by CEOs and corporate personnel who rarely possess clinical experience. In fact, some medical directors have an M.D. behind their name, but have never actually practiced medicine outside of residency!
- As they can also afford the best medical care, the business team has have no idea how it feels to be a patient on the receiving end of purely economic-inspired decisions.
- Ultimately, increasing rules and regulations land on physician shoulders, since it's only through physicians that corporate overlords can make money.
- To make all this happen, doctors are often expected to see up to twenty patients per day. This is true of both clinic and hospital physicians, and it causes a variety of dangerous and disheartening conditions:
- This is an important example: I used to work in a crazy busy hospital with low-SES and complex patients. Occasionally, each Hospitalist had to round and write documentation on up to thirty patients within a single, 12-hour shift. Doing the math - and assuming the doctor does not take a lunch break - the Hospitalist had a maximum of 24 minutes-per-patient. If half that time is spent documenting, the Hospitalist has a mere 12 minutes-per-patient of real, face-to-face conversation time! Whether a patient is severely ill; ready for discharge; or simply has family needing to ask questions, twelve minutes is a joke.
- This limited patient time not only causes unhappy patients and families, but can result in dangerous situations such as:
- missed information;
- and/or detection of abnormal labwork.
- Doctors dislike this broken system just as much as patients do. Physicians tend to assuage their guilt by spending more time with patients than their patient load allows, forcing them to do their documentation after-hours. This is just one of many reasons doctors have higher divorce rates than professionals in other occupations.*
- Subsequently, patients have less face-to-face time with their doctor, assuming they even get to see their preferred doctor (usually, patients must agree to see whoever is available if asking for a same-day appointment).
- Patients are then forced to make more appointments, since there's only time to address one or two concerns in a 15-minute appointment.
- As there are always some patients with unexpected, urgent conditions (e.g. chest pain; severe depression; shortness of breath), the physician inevitably ends up taking more than the allotted 15 minutes for these few patients. By the afternoon, the doctor is apologizing to understandably angry patients because the patient with the 1:00 appointment is being roomed at 2:30 (or a patient admitted at 2:00 AM is only just being rounded on at 3:00 PM).
- And finally, the good doctors - the ones who went into medical school with idealistic goals of "changing the world" and having meaningful relationships with patients - realize they're a money-making cog in a machine that...well, totally sucks. To quote Rebecca Etz, an anthropologist who attended the 2015 Family Medicine Keystone IV Conference:
"...[Doctors] feel under fire, holding strong, while also witnessing a certain amount of withering on the vine. It is as if they are bearing witness to the potential end of an era in which people in medicine matter."*
The simple truth is: American physicians are experiencing job burnout on an astronomical level.* They are also among the professionals with the highest suicide risk.* And despite all our advanced medicine, America has the worst medical outcomes of any first-world country.*
Team Ren is not your stereotypical medical group. We're not obsessed with prescribing drugs; we don't confine you into a time-limited visit; we don't ignore your personal health goals; and we're not a bunch of stressed out providers wearing starched white coats who spend the majority of a 15-minute office visit looking at a computer screen.
Let's face it: No matter how great the Primary Care Physician, the standard clinic model inevitably leads to long wait times, tired providers, and frustrated patients. By necessity, the physician house call is long gone; today's clinics cater to patients capable of traveling to the doctor. An unfortunate consequence of today's health system is the isolation of patients with mobility and transportation issues (mostly the elderly and/or disabled), who are subsequently left without access to routine medical care. Such patients have limited options, forcing their chronic health conditions to smolder until one finally turns into a blaze. By then, their only option is to summon the Paramedics - the only form of transportation available for some patients. The urgent ER trip inevitably becomes a hospitalization.
Team Ren is here to treat the patients forgotten by our nation's medical system. But patient intervention is not enough to evoke system change; therefore, our business also educates medical providers about Palliative, Home, and Hospice care.
RSHC was conceived by Dr. Vanessa Ren, a former full-time Nocturnist (a type of physician that oversees a hospital at night), specializing in critical care (e.g. Code Blues); end-of-life management; and treatment of late admissions. As time progressed, she became increasingly disturbed by the stories of elderly and disabled patients; specifically, the lack of routine health care. This was most problematic among the housebound elderly. Often, her patients were admitted for conditions that routine office visits could have prevented.
Having the empathy, resolve, and hospice experience to confront the needs of dying patients, Dr. Ren was always present for the bedside management of any dying patient. She personally performed all life-support terminations and Declarations of Death, allowing a patient's family to remain at bedside. She would talk family and nurses through the difficult process, ensuring the inpatient dying process was as painless as possible for everyone involved. These moments were, by far, the most meaningful of her hospital career. However, years of watching many patients suffer invasive - and often futile - treatments on life support left Dr. Ren with a heavy emotional and moral burden. Her regrets were shared by patients' families, many who voiced remorse over the decisions made during a loved one's final days.
Due to heavy patient loads, the average physician lacks sufficient time for family meetings and emotional discussions. Despite the "authority" conveyed by a white coat, physicians are just people; imparting bad news is as difficult for doctors as it is for anyone else. Sadly, our health care system deprives health professionals the skills, time, and/or experience to competently manage end-of-life conversations and treatment. The lack of thorough patient-provider communication results in futile treatments, with death often coming as a shock to patient families.
America's hospital model is one of "curing all ills," rather than treating a patient's needs. We forget to ask patients about their personal healthcare goals; we forget that, sometimes, healthcare is nothing more than emotional support and reassurance. Our current system hides an inherent injustice: any chance of cure, no matter how small, is pursued at all costs. This model not only fails to treat our nation's most vulnerable patients, it also tends to override patient preference. Dr. Ren realized that being a Hospitalist meant being part of a system that stole patients' final days at home, where they would otherwise be treated in comfort, surrounded by family.