David Kauff, MD, and I were talking about what it would be like in a true LEAN world to have a well adult visit, one that had as little waste as possible. We both know that most of the physical exam performed (such as listening to heart and lungs) in most adult physicals does not have any basis in evidence. In other words, we don’t know that using resources to perform this service on every patient is cost effective.
So what we talked about was a true “waste-free” visit. Patient wouldn’t say a word, we would ask for an arm to take some blood, get their cholesterol results, and provide them with the data and send them on their way. How would that doctor visit be like?
We then realized, it wouldn’t be LEAN, because it is not wasteful to touch a patient if that is what a patient is paying for. We know as physicians that both physicians and patients find it valuable to listen to heart and lungs and provide a healing touch. Value is whatever the patient is willing to pay for. LEAN is not designed to dehumanize the patient-physician relationship. It will enhance it by freeing up the physician and care teams to do what the patient is willing to pay for, to be healed.
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