From Transactional Tasks to Personalized Care: A New Vision of Physicians’ Roles

David B. Reuben; Christine A. Sinsky

doi:10.1370/afm.2203

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Table 1

Transactional and Personalized Aspects of Patient Care

Transactional	Personalized
Data gathering and entry	Synthesizing data from diverse sources
Most preventive care^a	Customizing care for individual patients
Guideline-based disease management^a	Adjudicating competing needs of multiple conditions
Disease-specific patient education	Negotiating individual treatment plans and agreeing upon expected outcomes
Documentation of care	Performing procedures and managing complications
Coding, billing, and prior authorization tasks	Advocating for individual patients

↵a Some preventive care and guideline-based disease management require shared decision making (eg, screening for prostate cancer, choice of medication) and are therefore personalized care.

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The Article in Brief

From Transactional Tasks to Personalized Care: A New Vision of Physicians' Roles

David B. Reuben , and colleagues

Background Changes in health care delivery have affected the work that physicians perform and, in turn, their satisfaction. This essay suggests steps that can be taken to align the current and future practice of medicine with the professional mission that motivates physicians and creates satisfaction.

What This Study Found Physicians should reduce their roles in transactional aspects of care, such as gathering and entering data, providing disease-specific patient education, and providing most preventive care. Instead, such duties should be filled by other members of the health care team with complementary skills, leaving physicians to diagnose and help patients meet personal goals and objectives. Physicians would provide personalized care by synthesizing data from diverse, often discordant sources; adjudicating the competing needs of multiple conditions; adjusting patients' treatment plans to align with their goals and preferences; and advocating for patients in a complicated, fragmented health care environment. To make this approach a reality, changes would need to occur on multiple levels including health care organization and delivery, technology, reimbursement, medical education, and practice and physician "buy-in."

Implications

The authors state that their vision would meet the needs of patients and society while closing the gap between physicians' intended patient care mission and their current transactional roles. In the process, they explain, physicians could discover joy, purpose, and meaning in their work.