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How to Fix Healthcare: A Manifesto

Op-Med is a collection of original articles contributed by Doximity members.
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Many of us have tried to come up with ways to solve healthcare. And just as medical students take a Hippocratic Oath before embarking on the wonderful journey of becoming a physician, we also must understand the basic principles when we enter into the field of healthcare. This is a manifesto to help us understand such principles.

Lay of the Land

One of the problems with healthcare in our country is that it is often NOT solutions-oriented. Many barriers are in place — whether by accident or by design — that perpetuate systemic blocks preventing people from getting the care they need. Such barriers can and do benefit individual and corporate actors, which ensure their longevity. Even once recognized, It is often hard AND costly to remove these barriers; in any case, doing the right thing does not always guarantee good outcomes.

So when things go south (as they often do when humans and illnesses are involved), our system is set up to seek and place blame under a punitive model, rather than find a solution-oriented method as a prophylactic measure against future catastrophes. And unfortunately, it is the people with the most dire healthcare needs who suffer the most under this system.

Once we view our system through the lens of avoiding blame for inevitable mishaps (all the while ensuring a strong stream of financial incentives for stakeholders), it becomes abundantly clear to us why many inadequacies have become so entrenched within our healthcare system. As well we see the many inherent fricative forces that make it particularly difficult to improve our healthcare system on any single front.

What we must do is dismantle the system and start anew. We must build a system where (1) thorough transparency, (2) ethical accountability, (3) collaborative effort, and (4) value alignment become our beacons of light. These four are the principles toward the quadruple aim: better patient outcome, reduced healthcare spending, increased satisfaction, and decreased physician burnout.

What Is Healthcare?

First, we must return to our inherent understanding of what healthcare is. We must understand why healthcare exists in the first place.

The reason healthcare exists is because people get sick and have medical problems. If people never got sick, the field of healthcare simply needs not exist. Our field exists to cure illness and alleviate suffering. We must therefore conclude: solving medical problems must be a necessary condition in all endeavors within our field.

We must remind ourselves of this incontrovertible conclusion, and we must strongly proclaim this as often as we can, for it is the one trait that sets healthcare apart from most other industries or fields. We are here to help people.

Healthcare as an industry exists because people require medical solutions to their problems. Therefore, the baseline goal in healthcare is to solve medical problems for people. That is, to help people.

The baseline goal of healthcare is not to make money.

It is not to accumulate power.

It is not to run and build organizations.

It is not to build the next cool product.

It is not to elevate the status of any one individual.

The baseline goal of healthcare is to HELP PEOPLE SOLVE MEDICAL PROBLEMS.

We must also avoid the trap of so solely concentrating on solving medical problems that we neglect to see if our actions are harmful to others. We also must strongly proclaim against systems and industries that are harmful to people — to patients who are already suffering. We take the pledge that whatever we do, we will do the maximal amount of good for the most number of people, and zero (or the least) amount of harm.

Seven Principles For Fixing Healthcare

Next, as physicians, we must discuss the most basic of principles before we can embark upon the path toward solving healthcare:

  1. We will fully respect patients’ rights and wishes and will do what’s right by patients: (a) Patients have the ownership rights to their medical records. (b) Patients have the right to choose treatment options, within the confines of their resources. (c ) Patients have a right to information that will do them no harm. (d) Patients have a right to tell us what they think they need.
  2. We understand our role in healthcare is to provide our skills, knowledge, and experience to accomplish the primary goal of healthcare; we will impart our values only when it is appropriate to do so — and where by doing so, we will not cause harm.
  3. We have the humility to understand that our way is not necessarily the only right way.
  4. We will give help where help is needed, within the confines of our resources.
  5. We will devote resources to the most urgent cases; we understand that if we help the sickest, all of healthcare will benefit.
  6. We understand when to profess ignorance and when to call in help from our colleagues when we need it.
  7. We will continuously monitor for any harm we might be causing and take the correct steps to rectify such harm.

The Heuristic Method

Once we are able to clearly and succinctly grasp the purpose of our actions, then we will be able to shape our solutions and methods. Within every step toward our ultimate aim, we ask ourselves: “Does what I do help solve someone’s medical problem? Does what I do have the potential of harming someone?”

Now, in order to fix a field as complex as healthcare, we will employ a method we know works well when it comes to treating human beings: we will invent a heuristic method.

We have already identified the ultimate purpose (the quadruple aim), but in order to ensure we are going down the right path, we will employ the strategy of continuous discovery. In common parlance, it’s “do what works”.

We strive to continuously evaluate the impact of our method then tweak to fit our method to the small, albeit well-defined, accomplishments.

In order to make this discovery process successful, there are several characteristics we must undertake: we must be open; be empathic; strive to learn and understand; be flexible; be creative; be humble.

In addition, there are several actions we will undertake at every step of the way to ensure we don’t go down the wrong path. We must ask lots of questions of the users; we must not allow our own belief system to superimpose upon the users’ needs; we must strive to understand the other parts of the system that can influence the users and our chosen method; we must employ continuous monitoring and adequate assessments; we must canvass for any harm done and take effective measures to minimize harm; we must have faith in the end users that they will choose the route that is most beneficial to their health. Our job is to help them understand their options; we must communicate when necessary; we must not ask leading questions.

Finally, we must understand that in order to collectively fix healthcare, we must collaborate with one another. We understand that the end goal is something much, much larger than ourselves — that to strive for that end goal is to help ourselves. To that end, we will ensure that the first and primary goal is satisfied — to help people and do no harm — before we strive for anything else.

Once we align our values, it will become clear the direction we need to take as a collective group of problem solvers. And we will have faith that as a living system, we will each be plugged in as an intrinsic and necessary node of the new paradigm of healthcare. And, those that do not align with our values will fall away, even with much fanfare and fighting. But we will have faith that they will ultimately not be sustainable under the new paradigm shift.

The Collaborative Model

In my field (pediatrics), healthcare providers intrinsically understand that it is never just the patient we are treating. In order to solve any pediatric problems, we must involve everyone in that child’s life. We first identify individuals whose values identify with ours. Our goal is the health of the patient. Therefore, we must bring on individuals who care as deeply about the health of the patient as we do — very often even more so.

Therefore, in order to fix healthcare, we must understand that in order to succeed, we cannot operate in solitude. We must be willing to collaborate with other individuals whose values align with ours and form a collaborative team.

Next, what we will do is bring our skills, knowledge, and experience to the table and collectively attempt to identify deficits within the system. Again, we will keep the collective driving principle in mind as we build teams and new systems: help people solve problems.

We will work together to identify needs and deficits within the system, and bring on members who are able to help, while paying close mind to reduce cost, and get closer to our end goal of better health.

We will continuously assess value alignment between team members and ensure each team member subscribes to the underlying value system of benefiting the patient, while doing no harm.

We will strive to work to build a system where interdependence is important, and we will not woefully ignore parts of the system that do not work. We must understand that everything we do is a node within a large complex system we call healthcare. And, just as a the way a net works, where there is a weak node that does not interconnect well with the rest of the net, invariably there will be someone who falls through the crack.

We will allow individuals with the most amount of skill, experience, resources, and knowledge to work on the part of the problem that best befits their background. And we will use the heuristic model to continuously assess benefits and harm. We will strive to find the simplest method to solve the widest array of problems.

We understand we each have a responsibility to speak up when we see something that isn’t working or something that is harming the patient or end user.


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