Peter Beck Kim's Other Blog

Think like me, agree with me

When you're trying to sell your idea, it's natural to assume that the people you're selling to think the way you do. If you can only show them the facts and stories that led you to believe what you believe, then of course they'll end up where you are... believing.

The problem, of course, is that people don't always think like you.

This is the kernel, the essence, of the dilemma for practicing physicians.

If only you knew what I know, seen what I'd seen, you'd be jumping at the chance to do what I'm telling you -- to turn your unhealthy habits around.

Of course, unless you're talking to another doctor, your patients haven't seen or studied what you have. Many will trust you and listen to your admonishments.

Many won't.

Seth Godin's post is the short version of his must-read book, All Marketers Are Liars (or the retitled version, All Marketers Tell Stories):

• People believe what they believe: their viewpoint.
• They will resist messages that counter their viewpoint.
• Ergo, you can piss in the wind, or you can reframe you message so it doesn't clash.

Pretty obvious, if you put it that way.

The problem for doctors is that they can't do what Godin and most internet entrepreneurs recommend as an option:

...perhaps you should only market your idea to people who already think the way you do. After all, you're not running for president, you don't need a majority. Screen people by their behavior (what they read, what they buy, how they act) and only tell your story to the people who will embrace it. That's a lot easier to do that than it's ever been before.

Physicians have a limited ability to draw only compliant, sensible folks. We have to deal with all comers, because everyone deserves a shot at a healthier life, not just those who agree with us. Very few folks like to hear that cheeseburgers and chili fries aren't good for them, so we're stuck preaching to people whose viewpoint runs counter to what's good for them, good luck with that.

Or are we?

Think about it: if you're a full-time primary care doctor, you care for something on the order of 2,000 patients. Is that the sum total of everyone in your geographic area? Not unless you're the only doc in a small town (then, you've really got no choice but to deal with everyone).

Practicing in a medium to large city or town, you're drawing from many, many more thousands, if not millions of potential patients in your immediate geographic area. Only a fraction come to you, and by mutual agreement, are cared for by you.

How do they and you pick? Until now, by multiople "non-you" factors (accident, geography, insurance type), and a few key "you" factors (people like you, and refer their family, friends, or coworkers).

Can a better job be done at matching up your practice with patients who will listen to you, so you just care for those who will "embrace" what you have to offer?

• Now that a majority of folks are on the Internet, and many are familiar with social media, texting, etc?
• Can you leverage an Internet presence to cast your net to your local millions, and draw in just a few thousand? Heck, that's just bread and butter Internet entrepreneurship, right there. Mavens have been doing that for years.

Simple, right?

If only it were. More on that next time.

By Serena Gordon
HealthDay Reporter

THURSDAY, Nov. 12 (HealthDay News) -- Like most people, I've been following the news about the H1N1 swine flu with some concern. Unlike most people, however, I've spent years interviewing doctors.

A first hand report of why tangoing with H1N1 is no picnic when you've got a chronic lung condition.

Read all the way to the bottom of this article from Bloomberg.com.

This is the first time I've heard about "crowding out" of one flu strain by another -- in this case, the swine flu strain seemingly suppressing the appearance of the regular seasonal flu. And epidemiologists and infectious disease experts still aren't quite sure how it happens -- or how reliably.

As one put it, "It’s probably still a very good idea to get vaccinated, because this is not over...I don’t have a crystal ball, but we had two historical pandemics where there was an early fall wave -- 1918 and 1957 -- and both of those were followed by a winter wave.”

Do you remember Dan Pink's book, A Whole New Mind?

Groundbreaking stuff from just a few years ago, that's withstood the test of time.

• A new, larger segment of the economy, based on right-brain creative and innovative activities? Check.
• Increased outsourcing to overseas talent as digital communications break down walls? Oh, absolutely Check.

That's already happening in medicine, with medical tourism -- notably, to the wonder clinics in Thailand. And as Dr. Davis Liu points out in his article, it's even happening with radiology interpretations, with the images being beamed out to be read in Australia and India, for 1/3 our cost.

Do globalization and tech translate into primary care medicine becoming THE most solid career choice for future doctors?

Maybe. There's only so much you can ship overseas, and travel is still kinda pricey. Someone will have to manage everything that you can't ship out, or manage by e-consult -- the primary care docs, Dr. Liu posits.

Pink argued that you want to get thee hence, pronto, to a line of work that isn't easily replaceable, via technological advance and global outsourcing. That has invaluable, unmatchable experience on the ground that simply can't be appreciated or implemented somewhere else.

Essentially, that can't be rendered down into a commodity to be bargained down, or digitized and handed off.

I'm just not sure that primary care medicine entirely fits that bill -- much of what PCPs do can be done more cheaply by nurse practitioners and physician assistants, and so is subject to commoditization forces. But if PCPs evolve, they can also take on tasks that were previously in the purview of specialists, so it's kind of a wash.

There's no substitute for reliable, capable eyes and hands on the ground; there will always be a niche, and a demand, and a need, for primary care physicians.

If we can just get the word out to med students, who have been running in the opposite direction for years, and survive the next few transitional years where the medical demand outstrips the PCP supply, we ought to be just fine.

Primary care doctors -- family practitioners, pediatricians, and internists -- have known about this for years.

Fewer and fewer med students are going into these fields known as general medicine. 20%, like this CNN article cites, is optimistic.

Primary care medicine is more than the pointy tip of the healthcare spear. It's the tip, the blade, and about 90% of the shaft. When your spouse or coworker or friend tells you, "You should see your doctor about that," the word "doctor" almost certainly means "primary care physician."

Primary care physicians, or PCPs, are trained to take care of the majority of problems, from cuts and sprains to flu and pneumonia. Contraception, minor surgery, blood pressure, cholesterol, obesity, and diabetes? Bread and butter primary care medicine. Depression, stress, and anxiety? All in a day's work for a PCP.

America needs more PCPs. But it's not getting them.

It's a simple equation: as a med student, you will help people no matter what specialty you go into. You'll do yourself proud, work harder than you ever dreamed, please your family, and have grateful patients who get better because of you.

So do you go into primary care, which pays a half to a fifth of what other specialties do? With more insurance hassles, decreased reimbursement, and guaranteed increasing patient loads?

If you think young doctors don't think in these terms, you're dreaming.

Practicing PCPs are hanging on for dear life, with plenty of them deferring retirement indefinitely. It's a Pyrrhic catbird seat kind of thing, as the PCP demand increases and the supply dwindles. Great time to be a PCP, right?

Right.

Eventually, older PCPs will retire, likely in a sudden ka-chunk. Lots of tight smiles in the healthcare system, then.

Reform needs to be multifactorial -- making prevention and responsible self-care sexy and desirable, rewarding quality instead of quantity care, policing the insurance companies, and propagating technology to bring the industry into the 21st century, geez.

But think about the military. The mission critical military.

Can you win a campaign -- any campaign -- without troops on the ground?

You know why the spear is used as the military analogy -- why it's "pointy tip of the spear" and not "pointy tip of the knife," or "cutting edge of the sword?" Because fancy talk aside, when you were in the muck fighting with edged weapons, you took the field with spears.

Remember the healthcare spear, and who makes up all but the butt end of it.

We won't throw away shiny swords. But if you get a chance to tell anyone who might listen back at HQ -- and remember, in this age, we're just one degree removed from anyone influential -- have them send more spears.

Please.

As I've gotten older, I hope to have gotten wiser -- at least, a little bit.

Vaccines are a pushbutton issue for most physicians. We all have buttons that take us from zero to sixty -- abortion, freedom of speech, sexual orientation, prayer in schools.

For doctors, it's shots.

This Newsweek article says things, firmly, frankly, yet equitably, that most doctors believe, yet increasingly many are hesitant to voice, due to a growing "anti-vaccination movement." That's a shame, since physicians in training are exposed to illnesses and complications that would push the average layperson into a state of catatonic shock. And we'll see more of those days, if we keep marching backwards one step at a time.

My own family immigrated from Asia one generation ago; we routinely hear things that make us give "WTF?" looks at each other.

Don't these people know how good they've got it? Don't they know they're one flight, one sneeze, one hydroplaning car ride away from getting turned upside down?

Don't they realize the rest of the world lives like this?

It'd be easy to pass this off to "dumb wealthy folk," so divorced from The Real World that they focus their passion on that teeniest sliver of possible risk.

But folks are folks. Social media and human psychology tell us that. We focus on what we perceive as the most real threats. We may be misguided and wrong in what we identify as threats, but we react to threats and needs and wants pretty much the same, worldwide.

That's why I don't roll my eyes too hard.

Because, as a physician, the line "If only you'd seen what I've seen, and know what I know" generally gets you nowhere -- unless you're talking to another doctor.

Focusing attention on getting other messages out there, that address people's existing concerns and fears and desires -- much more likely to be successful.

It's that social media mantra: It's not about you, it's about the other guy, for the other guy.