Beyond Fighting Fires: How Clinical Skills Can Change The Weather

Dr Gaj Panagoda, CEO Xstitch Health

Photo by Tak Kei Wong on Unsplash

Specialist doctors invest years understanding a focused discipline. They learn to diagnose complex conditions, interpret intricate test results and perform specialised procedures.

But what if this expertise could create impact beyond the examination room? What if clinical skills could be applied to reshape entire communities and health systems?

The healthcare landscape is rapidly changing. Electronic systems have transformed knowledge accessibility, making some traditional aspects of medical training increasingly outdated. Adaptability for better doctor-patient interactions is more important that memorising information.

This evolution raises a fundamental question: 

In an era when information is readily accessible, but trust is harder to earn, what should be the focus of specialist doctors?

The Current Misalignment: Expectations vs. Reality

There is a disconnect between public expectations of specialist doctors, and how specialists perceive their own roles. While medical training emphasises disease-based scientific endeavour, patients increasingly value communication skills nearly as highly as clinical judgment and compliance with legal standards (Chandratilake et al., 2010). Yet the resources devoted to developing communication skills are often far less than those dedicated to clinical judgment.

This misalignment exists within a broader context where:

• Specialists often work in centralised institutions, distanced from those with the highest risk of poor health

• Traditional funding models constrain specialists to activity-based care rather than population-level impact

• Medical hierarchy can create barriers between specialists and the communities they serve

There has long been a social contract between medicine and society: doctors that service society’s health needs receive status and financial rewards. In an era when the system often rewards transactional medicine, the social contract requires clarification (Milligan & Winch, 2012).

Our research on how marginalised people in the community view medical specialists was exhibited at the International Forum on Quality and Safety in Healthcare. Our findings revealed a common theme: specialists are expected to understand key aspects of patients' lives and environments beyond just pathology. Patients don't see this understanding as mere politeness, they consider it essential to effective treatment.

The Xstitch Approach: Reimagining Specialist Impact

Xstitch Health has reimagined the medical specialist's role by addressing the fundamental constraints of traditional healthcare models:

From Activity-Based to Systems-Level Impact

Traditional healthcare funding ties specialists to a cycle of episodic, one-to-one appointments. While these remain essential, there is limited ability to address root causes and create systemic change.

Xstitch's business-to-business model eliminates typical activity-based funding constraints, creating an environment where specialists can apply their clinical skills at a community level. Rather than funding specific activities with narrow outcomes, our approach focuses on building sustainable capability and resilience within partner organisations.

From Individual Encounters to Community Connection

At Xstitch, our medical specialists become catalysts for change by:

• Applying clinical expertise to identify patterns across populations rather than just treating individual cases

• Using communication skills to bridge the gap between medical knowledge and community needs

• Working collaboratively with community organisations to design interventions that address social determinants of health

We found that communities seek medical specialists who demonstrate authentic interest in their lives and environments. At Xstitch, this isn't just good bedside manner, it's fundamental to our approach to healthcare transformation.

From Hierarchical to Collaborative Models

The traditional medical hierarchy, while efficient for certain aspects of healthcare delivery, can be counterproductive when addressing complex community health challenges. Xstitch creates a space where:

• Clinical skills inform solutions but don't dictate them

• Community expertise is valued alongside medical knowledge

• Collaborative approaches replace top-down directives

A New Professional Identity: The Weather-Changing Specialist

Medical specialists at Xstitch have a unique opportunity to help bridge this gap by applying smart business principles to purpose-driven work. Clinical skills, informed by years of training and practice, become invaluable tools for systems-level change when combined with:

• A healthy dose of curiosity that leads to asking questions rather than prescribing solutions

• Humility that acknowledges the limitations of traditional medical hierarchies

• Communication skills that translate complex medical concepts for diverse audiences

• Experience in areas outside medicine that provide fresh perspectives on healthcare challenges
  
  

Why Now? The Timing is Perfect

The COVID-19 pandemic demonstrated that early involvement of communities can facilitate rapid change and action (Crooks et al., 2020). This precedent, combined with growing recognition of the limitations of traditional healthcare models, creates the perfect environment for specialists seeking meaningful impact beyond conventional practice.

Research shows that healthcare systems can change when new models of care emerge, though resistance often occurs when deeply seated cultural factors are challenged (Braithwaite, 2018). Xstitch provides a framework for meaningful change that addresses both the systemic and cultural barriers to healthcare transformation.

The UK’s Future Doctor Programme (2022) identified core medical skills will soon include understanding systems to optimise patient participation, empowerment and advocacy. Xstitch aims to be at the forefront of this evolution in medical practice.

Join Us in Changing the Weather

Current medical training hones clinical skills to fight healthcare fires: diagnosing and treating problems with precision and expertise. At Xstitch, we use these same skills to change the weather: creating conditions where communities thrive and health disparities diminish.

When specialist doctors bring their expertise to Xstitch, they join a community of forward-thinking people who are:

• Reimagining healthcare delivery

• Addressing social determinants of health through innovative partnerships

• Creating sustainable systems change rather than episodic interventions

• Finding renewed purpose and meaning in their professional identity

Clinical skills are too valuable to be confined to traditional practice settings. Join us in changing the weather for communities in need.

References

Braithwaite, J. (2018). Changing how we think about healthcare improvement BMJ, 361, k2014. 

Chandratilake, M., McAleer, S., Gibson, J., & Roff, S. (2010). Medical professionalism: What does the public think?Clinical Medicine, 10(4), 364-369. 

Crooks, K., Casey, D., & Ward, J. S. (2020). First Nations peoples leading the way in COVID-19 pandemic planning, response and management. Medical Journal of Australia, 213(4), 151-152.

Milligan, E., & Winch, S. (2012). Power and duty: is the social contract in medicine still relevant? The Conversation.

Panagoda, G. (2024). When chatting creates change: Transforming medical specialist roles for public value. Presented at the International Forum on Quality and Safety in Healthcare, Brisbane Australia

The Future Doctor Programme. (2022). NHS Health Education England.

Xstitch Health represents an innovative approach to healthcare delivery. By implementing a business-to-business model, Xstitch eliminates the typical activity-based funding constraints that often hamper healthcare initiatives in the social sector. Rather than funding specific activities with narrow outcomes, the approach focuses on creating sustainable capability and resilience within partner organisations.