A widening divide: the new schism in healthcare

Although the trend has been there for a while, it's become increasingly apparent to me over the past few weeks that there truly is a schism in the evolution of healthcare in the United States. On the one hand, we have the "big boys" (e.g., large hospital corporations, insurance-backed ventures, etc.) that want to move everything towards greater degrees of automation. If we can ask the super computer Watson to give you a diagnosis, why bother with an actual doctor? Let's attempt to increase utilization of telemedicine at every turn. Farm out increasing amounts of work to support staff with intent to preserve the time of the doctor only for the neediest and most complex of interactions, no time for the mundane day-to-day of typical chronic disease. As someone who grew up with the evolution of the personal computer and feels far more comfortable seeking what I need via my handheld device versus calling an actual office to request an appointment, I'm certainly down with the convenience factor. But that's pretty much where it stops. 

On the other side of this great divide, we have the "little guys." These are the cowboy doctors who continue to bank on the utility of their education, experience, and ability. They are pushing to slim things down, eliminate the excess overhead and meaningless metrics that drive up costs and instead focus on high-touch personalized medicine. Bring the relationship between you and your doctor back to the forefront. Recognize that seeing a patient as nothing more than a series of data points up until she finally visits with you in her moment of highest need is in fact, not a great way to go about providing high quality care. Instead, it allows for greater fragmentation, lesser degrees of trust, and an erosion of the patient-physician relationship. 

The more I find myself looking at evolving trends in healthcare through this lens, the more intrigued I a about which side will ultimately prevail. On the one hand, the industrial complexity of healthcare as big business is certainly where the resources lie to continue investing and frankly, even forcing patients into these models whether we want it or not. Alternately, the cowboys are relying on the extraordinary dissatisfaction patients feel about the idea that they have become just a medical record number, a set of data points in someone's productivity metric, with little attention to how they truly feel after their interactions. 

I know that for my highest need (usually = sickest) patients, I am fearful of how much will be missed as they are forced through systems of fragmented care where the primary care physician's role is increasingly slimmed down rather than expanded to given us greater opportunity to really hear our patients, understand what is important to them, and see what is being missed. 

What will our systems of care look like when this division is complete? And which side do I want to be standing on - as a doctor or as a patient?