The History and Future of Healthcare

Like many people born in Dallas in the late 1950s, my early experience with healthcare was simpler. We wouldn’t know to call it a healthcare “system” for a couple of decades. I was born in the original St. Paul Hospital (when it was in Oak Lawn, not off Harry Hines). My twin sister and I had a pediatrician, Dr. Ramsay Moore, whom I have come to learn was quite a legend in Dallas. When he died, we got a new physician, whose name made us cringe— Dr. Payne. He was a fine man and caring physician, and we saw him for many years.

With this limited exposure to healthcare, I entered graduate school for healthcare administration in 1981. It seemed as if hospitals, physicians and patients had settled into the routine of using Medicare and Medicaid, created a mere 16 years before. The life of a physician seemed comfortable, at least to a patient. But when I got my first job in 1983, I learned quickly that times were changing fast in healthcare. In my first 12 months in the industry the Prospective Payment System, with its Diagnostic Related Groups, or DRGs, was all the rage. Actually, “rage” might be the best word to describe it. That feels like ancient history now.

Fast forward to today, and I am closer to the experience of physicians and patients than I would have imagined all those years ago. During most of my career I have been privileged to work for physicians and their patients at the Dallas County Medical Society. Though I am not a physician, I am keenly aware of the power of the physician-patient relationship, and the role it once played in our healthcare system. While this very fundamental relationship has been under siege for decades, it is my belief that we will come to rely on it once again to rebuild our nation’s broken healthcare system. It won’t be the same (Drs. Kildare and Welby can stay retired), but there are strong signs that indicate a return to these roots.

Many of the major strategies in healthcare reform today involve issues based in the physician-patient relationship. For example, work in progress on Accountable Care Organizations, Patient Centered Medical Homes, Primary Care Case Management, patient compliance initiatives, care navigation, creative plan designs, and Texas’ own Texas Medical Home Initiative, all point to a greater need for patients to have a personal physician who, together with that patient, understands and accepts this relationship. Yes, important questions remain unanswered— such as, are there enough physicians, physician assistants, nurses, and other critical members of the healthcare team? To whom will they be accountable—hospitals or other employers? There are indeed more questions than answers.

Despite all the angst about the changes under way, I believe that patients will continue to have faith in their physicians. There is a trust and bond that is created when one human being helps relieve the pain and suffering of another person. At that moment it is not a system it is a relationship. We need to do everything we can to support and encourage physicians and their fellow team members in their quest to build this relationship with every person in America. It is also within our reach to provide patients with the same opportunities I once had in a simpler “system,” a more coordinated system, so that hopefully they will come to know physicians like Dr. Moore and Payne.

—Michael Darrouzet is the executive vice president and CEO of the Dallas County Medical Society and the DCMS Foundation.

Posted in Expert Opinions, Hospitals.