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Unbalanced—The Evolving Medical Care Crisis: A Book Describing Medicine’s Blind Spot

Unbalanced—The Evolving Medical Care Crisis co-authored by Jerry Youkey, MD and myself (Spence Taylor, MD) comes out this week. The book analyzes the state of patient well-being in modern medicine using a variety of true case examples from South Carolina.

It shows that patient well-being, while often the objective, is frequently not the outcome.

Though we highlight only about a half dozen cases, we could have included many more. Our goal was not to perform a quantitative analysis. It was to demonstrate the common features of an evolving world where medical care frequently falls short from the perspective of the patient. In fact, we characterized our current situation as a Medical Care Crisis: the features of which include lack of availability to care, doctor burnout, corporatization of medicine and poor communication. The book is the impetus behind the creation of Integral Leaders in Health, our public benefit corporation devoted to the Crisis.

Ours is not the only book describing the Medical Care Crisis. Dr. Victor Montori of the Mayo Clinic wrote a book in 2017 called Why We Revolt looking at the condition from the perspective of the patient’s bedside. Dr. Montori, a practicing internist, concluded that a “quiet patient revolution” was already under way.

Patients have had enough and are seeking alternatives.

Dr. Montori gave multiple examples to support his views. Besides our two books, there are many other reports on the topic, most of which are cited in the books. While our works provocatively suggest we have a problem (where there is smoke, there must be fire), they are not definitive sources. Critically speaking, they suffer from two issues: their anecdotal nature and their contrary worldview – different from that of many leaders in medicine.

The fact that our book (and Montori’s as well) is based mostly on anecdotal evidence is irrefutable. We heard dozens of stories and hundreds of instances where patient well-being was not a priority. From a research perspective those numbers would comprise a healthy numerator for analysis. Admittedly, we do not know the denominator. And while we have rhetorically said that any case as egregious as some of those in our book is “one too many,” we admit that we could be sampling the outliers. No system is going to get patient well-being “right” 100% of the time. Accordingly, that allows some critics to dismiss our work (and some have) as anecdotally pandering to patients with unrealistic expectations.

The second issue, the contrary worldview— is an issue of unawareness. And it cuts both ways.

First, it is important to remember the experience of the book’s authors. During our careers, Dr. Youkey and I have held the senior-most leadership positions at every level in medicine. That includes a multibillion-dollar hospital system, a medical school, an academic health center, a 2,200 provider medical group and a self-insured organization with more than 16,000 employees that spent approximately $11 million a week for employee healthcare. As such, we have experienced the medical care environment as senior leaders from each of its four components—hospitals, doctors, payors and universities. And looking back, we too heard the noise about how our medical care environment often failed to support patient well-being. It was only after we had stepped away and experienced the medical care environment without a dog in the fight that we saw the global nature of the problem.

While we were active leaders, it was always there. We just chose not to see it (perhaps feeling powerless to fix it). It was a blind spot. In retrospect, the Medical Care Crisis is not anecdotal. It is real and it is getting worse.

Of course, this is how the issue cuts both ways. Within the medical care environment leadership – the leadership that controls the public narrative – there is a general lack of awareness and thus a lack of attention to the Medical Care Crisis. Leaders cannot address what they consciously or subconsciously cannot see—again it’s a blind spot. This is not a criticism. This is simply an acknowledgement of reality. I have great sympathy for these leaders. In fact, I am one of them.

The way forward of course is to raise awareness. Our experience tells us that to do so will not take much effort. We simply need to listen to our patients and provide a platform for their stories to be heard. And their stories need to be taken seriously. This raises other questions. What is the science behind the Medical Care Crisis? The science behind “patient well-being?” How do we measure it? How do we monitor it? How do we change patient well-being from an anecdotal event to a scientific outcome? One of the motivations for writing Unbalanced—The Evolving Medical Care Crisis was exactly that: to make patient well-being “a tangible thing” in which we strive to achieve.

If patient well-being is no longer the priority, it’s time to bring awareness and academic rigor to the situation. Only then can we start to address the Medical Care Crisis.


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