Potent Medicine

ThedaCare Center for Healthcare Value (2012)

In his hard-charging debut, On the Mend, Dr. John Toussaint introduced readers to the efforts of ThedaCare, a five-hospital system in northeastern Wisconsin, in redesigning healthcare delivery through lean transformation by building a culture of continuous improvement. But delivery is only one side of the game.

Potent Medicine, the compelling follow-up to On the Mend, focuses on two additional key components in creating a value-based healthcare system in America: payment and transparency. The book includes eye-opening accounts from the physicians and system leaders who stood on the frontlines during the development of Wisconsin's most innovative healthcare organizations, and from the patients they're trying to help.

Winner of the Shingo Prize.


Nathan Grunwald is the future of medicine and he is worried. A primary care physician in ThedaCare's Menasha Clinic just five years out of medical school, Dr. Grunwald is also a pretty modest guy and would probably want me to point out that he is just one piece of the future of medicine. He is worried for good cause, though, since healthcare's center of gravity is shifting to the family doctor and there are too few to go around.

During medical school in Milwaukee, people would tell him that he was a smart person—too smart for family medicine. He could go into any of the specialties, they said, and make a lot more money. All of Grunwald's professors were specialists—as is true in medical schools around the country—and each talked up the importance of his or her field.

Grunwald loved those six-week rotations through cardiology, orthopedics, gastroenterology, pediatrics, and OB/GYN. Finding that he enjoyed all the specialties confirmed his decision to go home to Neenah and be a family doctor. But he still finds himself defending his decision sometimes.

"I love my job because, when a mother comes in with a fussy child, I can diagnose and treat the child's earaches, and then help that mother with her sleeplessness, and maybe take a look at her husband's rash and treat that too. Who has time to go running around to all those specialists?" Dr. Grunwald said. "This is so much more cost effective."

To offer quality healthcare to all—including an estimated 30 million Americans that are currently uninsured—we need general practitioners like Dr. Grunwald. Primary care doctors intervene early to keep minor maladies from becoming life threatening. They catch and relieve childhood asthma, tell us when we are putting on too much weight or when our blood sugars are out of whack, track our vaccines, flu shots, and cancer screenings. Half the babies born in Wisconsin do so with the help of a family doctor. Dr. Grunwald knows the critical position he occupies and is caught between his vision of quality and an increasingly dire sense of necessity.

"I would love to spend an hour with each patient, to make sure they are getting really top-notch care. But there aren't enough of us. People are being left out if I'm spending all the time I want with each patient. Patients are not getting care if they aren't being seen," Dr. Grunwald said. "I'm nervous about how we will meet patient needs in the future."

The Association of American Medical Colleges estimated that the country needed another 9,000 primary care physicians to meet medical needs in 2010. In 2025, we will be short by 65,800, Yet, the number of medical students entering family medicine fell more than 25 percent between 2002 and 2007.