Wednesday, October 25, 2006

Back to Your Health, continued....

There will no doubt be concerns about a clinic environment as has been brought up in our comments by our most loyal viewer and blogger himself, Bruce. I believe this is stirred up by visions of free clinics from the inner cities in the seventies and eighties. I believe actual experiences people have had at an efficient and well run clinic would alter some opinions. Also, doctors offices have become a clinic of sort, in the sense that they may have various practitioners and services available, and in the worst way in that and who has not had a long wait at their doctor in the last decade, as they overbook their schedules to make up for cancellations and the lower reimbursements they get from insurers? I am not making this proposal to make either patients or physicians unhappy, as both are groups I am trying to help with my work. Rather, I am trying to recommend that in many instances we take the business out of medicine, that has reached a point where to maintain a thriving business, a physician may have to get too aggressive, and areas that a physician, in general, may not want to have to deal with anyway. Give the business end to the businesspeople who spend their entire day just worrying about that stuff. Also, it can be set up to give physicians clear direction, incentives, and a communal atmosphere of working on the patients behalf, instead of the Utilization Review Committee of a far distant insurer sitting around making those decisions. For the patient, the biggest change could be one of location, and possibly less convenience in this area, but, for follow-up and specialists, possibly more convenience, to offset this for those who will need the most care and visits. There will be no perfect solution for every constituent, but there is no perfect healthcare environment now, for just about anybody. The key will be to maintain what is great and innovative about our system, and combine that with the comprehensive reforms necessary to secure the system for the future, and at the same time to move progress forward in, among important areas; infant mortality, healthful longevity, infection control and the minimization of mistakes at every juncture of care. This will need to come about through better treatment for drug and alcohol use and nutritional understanding, better preventative medicine and better community awareness of what healthy eating and general health habits are, more open yet secure collaborative information systems and more stringent guidelines over antibiotic use along with better use of the information systems coupled with a team approach to practice which could yield better and more consistent medicine. All the tools we need exist or are being developed. We need open mindedness and willingness from the top echelons of our goverment down to each and every medical provider and consumer. We need to understand that there is a crisis. We need a crisis mentality. We have not seen one from our government officials since the early nineties. It is time to focus on these national issues now, before they will cost ten times as much, and with much more painful solutions, for our children and children's children in the future.


Bruce said...

Yes, indeed! Most physician's offices have become quite clinic-like. Truth be told, docs are no more happy with this situation than their patients.

Relieving the business end from docs would [for them] be refreshing and raise significant fears. Docs [correctly] perceive managed care as having succeeded by siphoning off profits from professionals and giving them to silk-suits. They will be suspicious of proposals to limit their control. Thus, your proposal would have to include salary guarantees of some sort.

I agree that a crisis mentality is one seems willing to spend the political capital...the Clintons spent much of theirs years ago. Not since then has an influencial politician [of any stripe] been willing to risk political capital on this issue. That has to change.

My fear is that the system will have to break more before there is momentum. I hope I am wrong.

Larry said...

I think the system is broken enough to effect change if the willing politicians are elected. The salary guarantees would be the job---like for anyone else. It would actually put more control of the care into the hands of the physicians. There would merely be more salaried practitioners and less self employed. That would be the greatest change. While it would rightly be presumed that some income was siphoned off to the business end, the high medical inflation rate that has been slightly tamed, is where money was also cut out.