The difference between fatigue and hip replacement

Two kinds of care exist in healthcare - scripted and unscripted care. 

• Some treatments, like hip replacement, occur after a diagnosis has been made and getting the best result is facilitated by systems that ensure all the necessary steps are taken and are of high quality. You need to get antibiotics at the right time, work with a surgeon who completes many of these operations on people like you, and you need to start physical therapy quickly during your recovery, for example. This type of treatment is highly scientific.
   
• Other problems are less scripted. If you are seeking to understand why you are fatigued, the potential causes are almost endless, and you need a skilled provider or team of providers to ask you questions, examine you, and order appropriate tests to help "rule in" or "rule out" potential causes. Sometimes you'll start effective treatment. Other times treatment might not work or you have side effects that require modifying the treatment plan. While medical science is important here too, there is more "artistry" involved in this type of process.

In his book The Innovator's Prescription: A Disruptive Solution for Health Care the late author Clayton Christensen describes separate business models that are needed to address these two types of problems - what he calls Value-Adding Process Businesses and Solution Shops. He states that one problem with the healthcare system is that is tries to use both business models in the same places, leading to inefficiencies for both.

Why this is important:
Knowing this paradigm, you can use your knowledge to help you get the best care as you engage with the medical system. The questions you ask will be different depending on what kind of problem you need help solving.

• Scripted care: If you are getting your hip replaced, you might ask How many of these do you do? What is your complication rate? What quality benchmarks do you track and meet? Answering such questions can help you confirm you are in good hands.
   
• Unscripted care: For these type problems, different questions become important. How does this provider approach helping me find answers? Are they curious? Thorough? Have they helped people like me? Will they answer my questions and help me understand my diagnosis and treatment? Knowing you are in the right place may require more trial and error and intution.

While this is overly simplified, and many medical problems require both types of care, thinking about where your problem falls on the spectrum of diagnosis may help you navigate the increasingly complicated healthcare system as you select those you will trust to help you.

Going Deeper:

• The Innovator's Prescription book (summary here)

Have a super week,

Dr. Topher Fox

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