INTERVIEW: Victor Montori on “de-industrializing” medicine

January 5th, 2018

The Lown conference is known for attracting experts who speak out boldly on issues that matter… and this year’s crop of speakers may be one of our best. So we’re conducting interviews with our keynotes as we lead up to the main event April 9-10 in Washington DC.

KEYNOTE INTERVIEW: Dr. Victor Montori, diabetes doctor and researcher at the Mayo Clinic. He is one of the most cited clinical researchers in the world, having authored or co-authored over 580 research articles, and a recipient of the Karis Award, a patient-nominated recognition. In 2016, Victor founded The Patient Revolution, a nonprofit organization dedicated to advancing careful and kind patient care for all. His book, Why We Revolt, is a series of personal essays describing what is wrong with industrial health care and proposes a revolution of compassion and kindness in health care. 

Lown Institute: In your experiences practicing medicine in both in the Peruvian and American health care system, are there any problems these countries have in common?

Dr. Victor Montori: In both health systems, it is incredibly hard to practice kind and patient-centered care. In Lima, myself and my fellow trainees were completely overwhelmed with the seemingly never-ending line of patients needing care. One of my colleagues wrote a graduate thesis in which he noted that clinicians at patient rounds almost never acknowledged the patient’s existence: no greeting, small talk, explanations, nor elicitation of worries. We saw patients almost as interchangeable.

In the US, we are pushed to be more productive, to see more patients and make more revenue, and this also leads to seeing patients as a blur. Petty rules are enforced strictly with no flexibility for patients who need it. These are systems of industrial health care, structured by policies and procedures that discourage people from noticing. In these systems, both the patient and the clinician become dehumanized, which creates a vicious cycle of cruelty and lack of empathy for each other. When we do take the time to connect with patients and care, it is almost by accident. 

Do you believe the solution to these problems can come from within the current system?

The solutions for health care reform we hear about always involve a “disruptive innovator,” someone who finds a way to make a lot of money by providing a better service. This gives people the illusion that what we need is new thinking in same system. Patients invariably lose in that proposition. It would be great to start hearing, “How do we develop the next Doctors Without Borders?” instead of just another startup to benefit investors.

What is your vision for the next health system?

To counter industrial health care, we need to put individualization first and foremost – the idea that every patient matters. The next health system has to be efficient and sustainable, but not lose sight of patient care when trying to be productive and innovative. We have to hold ourselves accountable to each patient, know their biology and biography. 

We talk a lot about policy changes we need for the next health system, but we also need changes in language. The language we use in medicine today shows how we have put money before patient care. “Medical loss ratio” is how payers describe the proportion of their income “lost” in paying for patient care. “Risk” is how much of their reimbursement health care companies spend on caring for people. We have become “providers” and “deliverers” of care, as if we bring care to patients in a box.

The health system I envision is one of kindness, elegance, and love. We don’t often use the word “love” to describe the doctor-patient relationship, but when we take the time to be fully present and emotionally available with each other, this type of love is healing for both parties. We laugh with each other, we talk and connect, we cry. With love, clinicians can better understand their patient’s situation and can begin to see the patient in high definition.