What @danielpink teaches us about medicine


Category : Medical Rants

Daily readers know that I have spent a few days reading Drive by Daniel Pink.  This short, entertaining book expands the ideas in this wonderful TED lecture –

Pink provides an overview of the motivation literature and emphasizes these issues:

  1. Motivation 2.0 rarely works.  Motivation 2.0 uses carrots and sticks.  This works well for simple tasks, but causes paradoxic outcomes for complex problems.
  2. Motivation 3.0 focuses on internal motivation – the joy of the task.  Intrinsic motivation trumps extrinsic motivation in most circumstances.

Medical care insurers (including Medicare) have focused on Motivation 2.0.  They hope to use rewards (P4P) and penalties (never events) to make us practice better.  They forget that medical care is complex, and often requires challenging thinking.  They discourage autonomy, and yet physicians crave autonomy.

We need new thinking about optimizing medical care.  We have too many studies that tell us we do not do a good job through performance measurement.  We have performance measurement studies because they can be done.  But the science of motivation tells us that true improvement will not come through rewards and punishments.

We have an insurance system that rewards us for bad medical care.  By paying for widgets rather than for medical care, we are encouraged to see more patients per unit time, rather than to optimize the number of patients per unit time.

We clearly need physicians to have the time to think and approach each patient with a full knowledge of that patient's situation and context.  Thinking time requires autonomy.  Our insurance system strips physicians, and especially primary care physicians of that autonomy.  No wonder the primary care job becomes less desirable each year.

I encourage you to watch the video (around 18 minutes) and then seriously consider buying the book.  We need to reimagine medical caring.  We need autonomy for physicians.  We need to pay physicians for care, not for visits.

Comments (4)

[…] I am currently re-reading Drive by Daniel Pink.  I have gone back to the words I wrote this January – What @danielpink teaches us about medicine […]

[…] I just finished reading Drive for the 3rd time.  The messages from this book are ones that the wonks should embrace, but that they will ignore, because the messages do not fit the conventional wisdom.  I wrote about this book 7 months ago – What @danielpink teaches us about medicine […]

Think this is an interesting commentary when talking about physician motivation.

[…] First he referred to Daniel Pink’s important book Drive. Here is what I wrote while reading the book – What @danielpink teaches us about medicine […]

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