We’re Looking at Healthcare All Wrong: Part 3

What you’ll learn:

There is so much discussion about the problems facing healthcare—and there are so many people and organizations responsible for pulling it in different directions. From the people responsible for delivering it to the people responsible for paying for it to the individuals and families receiving it, there doesn't seem to be consensus on what "good" looks like and on how we define value within the system.

What is valuable is largely determined by perspective.

In We’re Looking at Healthcare All Wrong, John Guarino shares how decisions that are rational for each stakeholder can still produce unintended outcomes at the system level. Clinical benefit is real but interpreted differently depending on who bears risk. Economic impact exists but is often captured by someone other than the innovator. Experience matters to patients and clinicians, yet is rarely priced explicitly. Total cost is carried by payers, employers, and the government, often disconnected from where benefit shows up. Time horizons almost never align.

This series examines healthcare by changing seats and explores how structure shapes behavior, why accountability fractures across settings, and what it would take to move from stakeholder optimization to shared ownership of outcomes.

I’ve spent years listening to physicians describe what it feels like to practice medicine inside the modern healthcare system. What strikes me is that most are not asking for unlimited autonomy, nor are they rejecting standards, oversight, or evidence-based care. Yet the public conversation often frames physicians as though they are simply resisting accountability or defending older models of independent decision-making. That interpretation misses what many clinicians are actually describing. What I hear repeatedly is not frustration with oversight alone. It is a frustration with fragmentation.

The Architecture of Interruption

Most physicians understand why the healthcare system evolved the way it did. Standardization, utilization management, and population-level oversight were introduced to reduce variation, improve quality, and control costs.

None of these constraints are inherently unreasonable. Yet physicians often experience them cumulatively. What appears to be system-level oversight can feel like interruption at the point of care. Individually, most of these demands are rational. Collectively, they fracture clinical attention. 

The frustration with fragmentation rarely appears in discussions about healthcare value because it is difficult to measure. Claims systems do not capture interruption recovery time. Quality dashboards do not quantify cognitive switching costs. Financial models rarely account for the clinical consequences of attentional overload, yet physicians experience those costs constantly.

The work of medicine is synthesis. A patient encounter is rarely about one isolated clinical question. Instead, it is the integration of symptoms, comorbidities, medication history, behavioral realities, social determinants, financial limitations, treatment preferences, adherence risks, and uncertainty. Good clinicians contextualize information. They do not apply protocols. Increasingly, however, the workflow surrounding medicine disrupts the continuity required for that synthesis. 

What many describe as “burnout” often looks operationally like attentional exhaustion. Physicians move continuously between portals, documentation requirements, inboxes, quality prompts, formulary restrictions, benefit investigations, referral rules, and prior authorization workflows while trying to preserve meaningful attention for the patient. Together, these interruptions reshape the cognitive environment in which clinical decisions are made.

The tension is often oversimplified as physicians versus payers, but the reality is more layered. Physicians themselves operate within incentive structures:

Clinicians are not neutral observers outside the system. They are participants with a uniquely difficult role. The patient may need one thing clinically, but the decision about that care is often shaped by multiple operational priorities. Sometimes those pressures improve care. Sometimes they distort it. Often, they do both simultaneously.

Where Guidelines Meet Patients

In oncology, for example, frameworks such as National Comprehensive Cancer Network guidelines have improved consistency and established minimum standards of care. Payers and health systems increasingly align pathways and coverage decisions around those standards because, at a population level, standardization can reduce inappropriate treatment variation and improve quality.

But guidelines describe populations, not the patient in the room. Physicians manage the gap between population-level recommendations and individual realities: frailty, comorbidities, prior toxicities, transportation barriers, caregiver limitations, and adherence concerns. These factors rarely appear fully in structured evidence models.

Operational priorities can begin reshaping clinical decisions in ways that feel disconnected from individualized care. Step therapy is one example. From a payer perspective, step edits are designed to encourage evidence-based sequencing and avoid premature use of expensive therapies when lower-cost alternatives may be effective. Conceptually, that is not irrational. But at the point of care, physicians may be required to document failure on a lower-cost therapy before a patient can access what they believe is the more appropriate disease-modifying option.

The same dynamic appears in specialty pharmacy and site-of-care management. A physician may believe integrated in-office dispensing would improve continuity and adherence for a medically complex patient, while a payer may require use of a mandated specialty pharmacy structured around network economics and utilization oversight. The therapy may remain unchanged, but the burden of coordination shifts to physicians, staff, patients, and caregivers as they navigate disconnected systems, shipment logistics, benefit investigations, and multiple communication channels.

Over time, clinicians are not simply practicing medicine. They are continuously translating between competing operational definitions of value: standardization versus personalization, affordability versus immediacy, utilization control versus therapeutic flexibility, measurable compliance versus clinical nuance. That translation work consumes time, and time scarcity may be one of the most underappreciated cost drivers in healthcare.

Meanwhile, the patient experiences all of this as a single story.

The Unseen Cost of Fragmentation

Every additional layer of friction eventually converts into something else. Visits become shorter. Treatment initiation is delayed. Communication fragments across portals, systems, and organizations that do not fully connect. Follow-up gets deferred. Practices require additional administrative support to manage the burden. Clinicians reduce clinical hours, leave organizations, or leave practice entirely. Patients experience confusion and uncertainty. Over time, trust erodes as operational complexity increasingly shapes the care experience itself.

The irony is that many mechanisms designed to improve value can unintentionally erode the clinical environment needed to deliver it. Consider network and privileging fragmentation. A physician may know the appropriate specialist, infusion center, or treatment pathway for a patient, yet contractual alignment, site-of-care restrictions, or hospital privileges redirect care elsewhere. The clinical pathway may be clear while the operational pathway remains fragmented.

What concerns me most is that healthcare increasingly behaves as though clinical attention is infinitely expandable. It is not. Attention is finite. Time is finite. Cognitive bandwidth is finite. Yet nearly every stakeholder assumes the clinician can absorb one more requirement, one more metric, one more portal, one more authorization, one more documentation field, one more interruption. Eventually, fragmentation itself becomes a clinical risk.

But oversight and fragmentation are not the same thing.

Navigating Targeted Friction

One of the most promising shifts in healthcare is the recognition that friction should be intelligently targeted rather than universally applied. High-performing and low-performing clinicians often face the same administrative burden. Straightforward decisions and highly uncertain ones may trigger the same operational resistance.

That is why meaningful alignment efforts are not about removing accountability, but redesigning operational architecture around clinical workflows:

These efforts recognize something important: reducing cognitive fragmentation is not merely a physician-satisfaction initiative. It is a quality initiative. It is an efficiency initiative. It may ultimately be a cost initiative as well. Because when clinicians spend less time translating between fragmented systems, they spend more time thinking clinically. And that may be one of the most overlooked truths in modern healthcare.

The patient remains the true convergence point of every stakeholder’s incentive structure. Physicians sit one layer upstream, attempting to operationalize those competing definitions of value while preserving enough continuity of attention to care for the patient in front of them. That work is becoming harder.

Not because medicine itself is becoming less evidence-based or less sophisticated, but because the operational environment surrounding medicine is becoming increasingly fragmented. The question is no longer whether healthcare needs oversight. The question is whether the system can preserve the cognitive continuity that complex care still requires.

Klick Health is the world’s largest independent commercialization partner for life sciences and a leading full-service pharma marketing partner, serving as agency of record for leading pharma, biotech, and healthcare brands. Klick’s specialized offerings are rooted in deep medical and scientific understanding, including market insights, award-winning creative, and proprietary AI and data models to craft impactful brand narratives and seamless customer journeys. Backed by nearly 250 medical experts and advanced healthcare analytics, Klick delivers integrated marketing strategy and communications, from new product launch strategy to MLR review with real-world evidence, helping brands thrive in today’s complex healthcare landscape. Learn more at Klick.com.