E. Ray Dorsey, MD, and George Ritzer, PhD, published a Viewpoint article in JAMA Neurology a year ago that has repeatedly resonated with me. These writers — a neurologist and a sociologist — recognize healthcare can be delivered in an individualized way, given the right conditions.
The writers describe how fast-food management principles have been applied to healthcare and the results of using this style. Four qualities define the McDonaldization of medicine, and each has its benefits and costs. Here is my interpretation of Dorsey and Ritzer’s table, depicting the effects of the fast-food approach on therapy services and therapists.
Dimension – Efficiency
Presentation – Use brief sessions and pre-set frequency/duration of treatment. Use questionnaires rather than observations. Focus on productivity standards. Provide fewer OTs and OTAs to produce more billable units.
Benefit – More patients are processed at a lower cost.
Cost – Patients receive decreased client-centered and holistic care, reduced interpersonal rapport and suboptimal outcomes. Therapists experience burnout.
Dimension – Calculabilty
Presentation – Count and record actions and easily measured outcomes. Evaluation, intervention and outcomes are measured numerically.
Benefit – Data can guide future practice and research.
Cost – Practitioners’ attention and time is diverted to recording data. Reduces care to small, discreet values, losing the big picture view.
Dimension – Predictability
Presentation- Utilize protocols, checklists and templates, plus scripted interviews.
Benefit – Ensures attention to a standardized set of critical factors and actions.
Cost – Can result in rote, automatic care that ignores unique needs and client motivations. Can obstruct building therapeutic relationship. Clinical judgment and creativity are stifled.
Dimension – Control by nonhuman technology
Presentation – Use electronic medical records that dictate clinical reasoning, billing codes and utilization review.
Benefit – Provides systematic, easy storage and sharing of information for patient care, program evaluation and research. Can ensure […]