Archive for August, 2009
Recent town hall meetings, as well as ongoing political and lobbying machinations, demonstrate the intensity of the issue of health care reform. One key element of the ongoing debate is the evolving support for the medical/health care home concept, as a mechanism for moving the transformational work forward.
My July 23, 2009 blog on the ideal relationship between patients and doctors elicited more comments than most of my postings. ePatient Dave was interested enough to repost that blog on his site, which elicited even more comments. One comment from Anne Marie Cunningham suggested that I read The Logic of Care: Health and the Problem of Patient Choice by Annemarie Mol, the Socrates Professor of Political Philosophy at the University of Twente, the Netherlands.
Last Wednesday, I did not think too much when I heard tornado sirens go off in St. Paul while I participated in a Minnesota Community Measurement Board retreat. We barely noticed the annoying noise and continued to plan for the future of public reporting of health care outcomes information that could help providers and consumers achieve better health. I was relieved to find that the rain had largely subsided when at 4:30 p.m. I made my way to my red Prius in the parking lot. Remembering that I had started a load of laundry, I decided to swing by my home on the way back to the ICSI office to catch up on emails.
We hear much in today’s health care dialogue (although perhaps shouting and name calling is a better depiction of the present state of discourse) about the need for transforming our health care delivery system. But while we hear of isolated successes from individual organizations, and creative efforts of individuals themselves, we have a long journey before we achieve the changes many of us feel are essential in creating a system which is truly patient centered, value driven, and economically viable.
Even though any health care reform that may be passed after the current debate will affect my generation and those that follow the most, it seems no one is asking the young what they want. I feel I have no control over the end results. Maybe people think we are uneducated about health care and don’t understand the issues. Maybe we are not invested enough in the issue. Maybe they think we are still too inexperienced in life and do not know what is best. Or maybe we are considered too idealistic or that what we want is major reform that could shake this whole country upside down. But young or old I think we can all agree we just want a better health care system.
I practiced medicine for more than 26 years as an internist. Subsequently, I’ve spent the last 7 1/2 years working at the Institute for Clinical Systems Improvement focusing on collaborative, evidence-based approaches to improving care. Our work over the past 3-4 years has become increasingly complex, moving from providing quality improvement training to our member organizations, to facilitating and convening multi-stakeholder initiatives addressing both practice redesign and payment reform.
Doctors in the United States are generally paid on a fee-for-service basis; the more services they order the more money they make. As outlined in Atul Gawande’s influential article “The Cost Conundrum,” The New Yorker, June 1, 2009, many of these procedures and tests are not necessary. They raise the cost of health care, but they do not improve the health of the patient.
OK, I admit it, I’m in the baby boomer generation. I have strong personal drive, passion for work, and commitment, but like many others my age I’m afflicted with a bit of an aversion to new and evolving technology. I’d resisted the temptation to upgrade my cell phone for months. “Why do I need an iPhone, I barely use my cell phone?” was my most common excuse.
American medical care costs too much and is contributing to economic conditions that are harming American employers ability to compete on the global stage and helping to cause unemployment rates that are truly disturbing. Are American doctors paid too much? Are American doctors paid in a way that contributes to wasteful and even harmful medical care? What is a fair wage for an American physician in 2009? Are American doctors businessmen who purvey services just like any other businessman? Are not physicians professionals who have special obligations to their patients and society? Is there really a battle for the soul of American physicians?