Vertical integration- one of the great medical lies

Something I've never heard from a patient "Thank god for a phone tree!"

.... I saw one of my favorite patients yesterday.  She was initially referred to me for neck pain, which we've treated successfully, but I also picked up an untreated concussion, which we've been working through.

She is super compliant, super motivated, and just super in general.  She also has a medical condition that I picked up, but is outside of my domain of experience, and really needs to be follow-up by her primary care physician ....

Which would be great, but she's been trying to get a hold of her primary care physician for the past 3 months, and can't reach a human being.  Her primary care physician is part of a large health conglomerate, and she is stuck in what I call "phone tree hell."

The solution is pretty easy- I work with some wonderful primary care physicians who are independent, and will be happy to see her, and treat her like family.

So the solution is pretty easy ... what's the problem then?  Vertical integration.

Vertical integration is the idea that if we take take all the different aspects of medicine and put them under one roof, we will have one-stop shopping, and a one-stop solution.  Another way of framing this issue is making the argument that medicine benefits from an economy of scale, and that by creating incentives to make medical practices bigger, we will prevent inefficiencies and improve care.

That has not been my experience, and it has not been the experience of my patients either.  One particular intervention that most vertically integrated organizations love using a phone tree, or central call system.  The thought is that it will improve efficiency and limit staff.

Let me ask you, the reader, how your experience has been with a phone tree?  Delightful?  Fabulous?

My experiences have always been awful.  I once had a patient who worked for Comcast's phone tree system, and he told me that their internal metrics for their call center were spectacular, even as they had to rename parts of the company XFinity because Comcast was nationally synonymous with horrible service (see here for more details).  What I was told was the Comcast scored their operators on two criteria - whether they were able to upsell, and how quickly they got off the phone.  It's easy to see why this would be valued within the accounting department, and hated my customers.

And this is exactly why we prioritize having an actual person at our phone, and having that actual person within a short walk of both Dr. Hyman and myself.  It's just one more detail that leads to true customer service.

Big health care systems - for people who wish their health care was more like the cable guy!