Medicine is in a time of change. Hopefully we can create a healthcare system that provides rapid access to quality medicine for all of us. The details will be difficult to work out, but there is no question that physicians should be involved in helping to craft the new plan.
After all, physicians ultimately know what the day-to-day care of patients entails and what issues contribute to making the delivery of quality healthcare efficient. Of course the creation of a plan will also require the input of other groups including politicians, various industries, and patients, but without physicians, there will be no healthcare, and it is important to hear their voices.
So what do physicians think? Who represents their opinions? What do physicians want in the new healthcare plan?
The AMA, founded in 1847, has typically been perceived as the "voice of physicians", yet physician enrollment in the AMA has waned to a current level of 245,000 members representing about eighteen percent of American physicians. I don't think it can be said any longer that what the AMA says is what physicians believe.
Recently, an organization called Sermo, the Latin word for conversation, has become active politically and has engaged in debates with the AMA on national television. Sermo has about 100,000 physicians in its community and it's CEO is Dr. Daniel Palestrant. Membership is for physicians only. Their relationship with the AMA is antagonistic at best.
These societies may be the only exposure the public has to the opinions of large numbers of physicians as a group, and the message sent by these societies greatly impacts how physicians are viewed and whether their message affects policy decision making.
So, how does the public know what physicians think? Upon visiting the website of the AMA, there is a section for physicians as well as one for patients. The section for patients presents resources on healthcare as well as the AMA's vision of healthcare reform.
Although they do not offer membership to non-physicians, Sermo does maintain a blog , accessible from their website and available to the public, which purports to represent the Sermo physician community's perspective on select issues, presumable issues selected by Dr. Palestrant. The blog is heavy reading and focuses mostly on physician discontent with the current healthcare system, rather than presenting to patients a discussion on how fixing these problems would improve healthcare for patients, ultimately what the public wants to know. Unfortunately it sounded like doctors complaining, rather than doctors working for a better healthcare system.
I posted a message on the Sermo message board suggesting that a section be created for patients, on which Sermo could explain the issues facing medicine, doctors, and what doctors think should be done to help our healthcare system. The responses reminded me of something I learned in college psychology. A rat was randomly shocked in order to create a stressful environment. A stuffed animal was placed in the cage and the rat attacked it. On the Sermo message board, I was the stuffed animal.
Although I explained carefully that I thought a physician-only organization was great, Sermo had an obligation to present a face to the public once they had entered the debate on healthcare. The Sermo blog does this in a sense, but is difficult to read. I suggested a simple link from the homepage to a site where the public could read about the realities of medical practice from the people on the front line, not from politicians and insurance companies. The response to my suggestion was unanimously negative. Doctors have become so stressed that they need a place where they feel safe. The sad thing is that doctors could help make the whole healthcare system a safer place for doctors and patients.
Medicine is an honorable field. I can think of nothing that feels more rewarding than making another person stop hurting, or fixing them when they are broken. Many years of training go into becoming a physician, typically at least eight years following college, and often several additional years. Physicians usually leave their training in enormous debt, and having sacrificed much of their youth to serve fellow humans. It used to be a sure bet that one would be successful as a physician, and physicians were a happy lot. Most physicians would not want their children to go into medicine. This is troubling.
In crafting a new healthcare plan we must not neglect the needs of physicians, but it is up to physicians to make their needs known. Both the public and doctors want the same thing and they need to be working together against the enormous political clout of the insurance and pharmaceutical industries that fear a loss of profits. Most doctors are in favor of a single payor system that would eliminate for-profit insurers and curb the power of big provider chains, thus allowing more dollars to go to patient care. This is similar to the 67% of the general public who support a single payor system. Doctors want healthcare decisions to be made by doctors, not by insurance companies. The New York Times reported that between 2000 and 2005 the number of Americans with private health insurance fell by 1 percent, while employment at health insurance companies rose 32 percent. The implication is that the insurance companies are working harder to decide who does and does not deserve healthcare. Denial of care is often a decision made by an insurance clerk with high a school education. The result is a burden on doctors to deal with the insurance companies when they could be taking care of patients and the need to see more patients in less time. Doctors views are really pretty much in sync with that of the public. Doctors can't be perceived as an isolated group of fat-cats that don't care about their patients and don't want to interact with patients except to make money. In general, physicians are people who want to help people, and they have chosen this path as a living. It's time for physicians to become the strongest unified voice for healthcare reform and I think the public will support them.In searching the internet for public opinion of physicians I found almost all positive reports. People seem to still trust their doctors. Doctors should stop complaining among themselves and lead the way to a better system. A good indicator would be when doctors want their children to be doctors again.
Showing posts with label AMA. Show all posts
Showing posts with label AMA. Show all posts
Wednesday, October 7, 2009
Tuesday, September 29, 2009
Medical Technology-confusing even in 1955
Medicine has changed so dramatically since I graduated medical school in the 1980's, that it is hardly recognizable.
Certainly there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path. For example, when advanced imaging techniques such as "CAT" scans and MRI's became available, we were able to see the inside of large numbers of patients but we didn't know what was really normal. One thing we found in quite a few people was a small growth on their adrenal gland. Many of these patients were subject to operations and it ultimately turned out that the growths were harmless.
This is one of the problems with undergoing medical tests. You have to deal with the results. Sometimes the results are incorrect, leading to further testing and treatments. Sometimes the results are correct, different than normal, but still harmless. An example of this would be the "bulging discs" seen on so many MRI's of the spines of patients with back pain. It seems logical to assume cause and effect in a patient with back pain and a spine abnormality, yet it turns out that bulging discs are a common finding and usually not associated with pain.
We have certainly improved our treatment in many areas of medicine, but it has come at a price, both in cost and in quality of care. Too many people can't be seen quickly. Our attempt to provide care for everyone gas created problems. We have lower level people doing higher level functions, and they simply can't do them as well. This ranges from blood drawing to EKG's. A controversial area is the autonomy given to caregivers that have less formal training than physicians, such as midwives, nurse anesthetists, and nurse practitioners. The overload of patients has led us to treat by email or video, an idea which is hard to accept when one learned that the basis of quality treatment is a good history and physical exam, neither of which can be done electronically.
Physicians had it good for a long time, and really didn't take care of the field. Now there is conflict between physicians and the AMA, and a new voice has arisen at Sermo
Unfortunately Sermo does not have a section for non-physicians, although I think it would be a good idea.
This post was inspired by an item in the Journal of the American Medical Asociation (JAMA) from December 24, 1955 by G.W. Pickering M.D.. It reads as follows:
Machine Age Overtakes Medicine-
As year succeeds year, some new physical or chemical technic and some new and elaborate machine are applied to the study of disease; great claims are always made for the precision of the answers yielded by these technics and machines. One of the greatest struggles that a practicing doctor has is to keep up-to-date with advances of this kind. No sooner has he mastered one than another is upon him. Moreover, the machines or technics are often so complex that he cannot understand them. He has to take what they tell him on trust...There is a growing tendency for doctors to rely on the information given by such technics and machines in preference to the information which they gain themselves from the history and physical signs. I am extremely doubtful if this is in the interests of good doctoring, and for three reasons. First, the errors and limitations of these new technics are not at first appreciated...Second, a thorough clinical examination, which will be carried out only by doctors who appreciate its worth, is the best method of establishing that spirit of mutual understanding and good will which is the core of the doctor-patient relationship. Finally, to rely on data, the nature of which one does not understand, is the first step in losing intellectual honesty. The doctor is particularly vulnerable to a loss of this kind, since so much of therapeutics is based on suggestion. And the loss naturally leaves him and his patient poorer.
End.
I think there was a lot of wisdom and foresight in this 1955 article. Technology has advanced medicine without doubt, but a good history and physical exam remain the basis of good care. The explosion of medical technology has introduced many useless and expensive technologies as well as pure snake oil, in addition to the useful technology. Marketing directly to patients has made it more difficult for physicians to practice good medicine and avoid the use of treatments that look wonderful on television but are not in the patient's interest.
We have a lot of work to do, but I think that physicians still have the best interests of their patients in mind and are the only ones who can fix what has broken, even if we played a role in breaking it.
Certainly there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path. For example, when advanced imaging techniques such as "CAT" scans and MRI's became available, we were able to see the inside of large numbers of patients but we didn't know what was really normal. One thing we found in quite a few people was a small growth on their adrenal gland. Many of these patients were subject to operations and it ultimately turned out that the growths were harmless.
This is one of the problems with undergoing medical tests. You have to deal with the results. Sometimes the results are incorrect, leading to further testing and treatments. Sometimes the results are correct, different than normal, but still harmless. An example of this would be the "bulging discs" seen on so many MRI's of the spines of patients with back pain. It seems logical to assume cause and effect in a patient with back pain and a spine abnormality, yet it turns out that bulging discs are a common finding and usually not associated with pain.
We have certainly improved our treatment in many areas of medicine, but it has come at a price, both in cost and in quality of care. Too many people can't be seen quickly. Our attempt to provide care for everyone gas created problems. We have lower level people doing higher level functions, and they simply can't do them as well. This ranges from blood drawing to EKG's. A controversial area is the autonomy given to caregivers that have less formal training than physicians, such as midwives, nurse anesthetists, and nurse practitioners. The overload of patients has led us to treat by email or video, an idea which is hard to accept when one learned that the basis of quality treatment is a good history and physical exam, neither of which can be done electronically.
Physicians had it good for a long time, and really didn't take care of the field. Now there is conflict between physicians and the AMA, and a new voice has arisen at Sermo
Unfortunately Sermo does not have a section for non-physicians, although I think it would be a good idea.
This post was inspired by an item in the Journal of the American Medical Asociation (JAMA) from December 24, 1955 by G.W. Pickering M.D.. It reads as follows:
Machine Age Overtakes Medicine-
As year succeeds year, some new physical or chemical technic and some new and elaborate machine are applied to the study of disease; great claims are always made for the precision of the answers yielded by these technics and machines. One of the greatest struggles that a practicing doctor has is to keep up-to-date with advances of this kind. No sooner has he mastered one than another is upon him. Moreover, the machines or technics are often so complex that he cannot understand them. He has to take what they tell him on trust...There is a growing tendency for doctors to rely on the information given by such technics and machines in preference to the information which they gain themselves from the history and physical signs. I am extremely doubtful if this is in the interests of good doctoring, and for three reasons. First, the errors and limitations of these new technics are not at first appreciated...Second, a thorough clinical examination, which will be carried out only by doctors who appreciate its worth, is the best method of establishing that spirit of mutual understanding and good will which is the core of the doctor-patient relationship. Finally, to rely on data, the nature of which one does not understand, is the first step in losing intellectual honesty. The doctor is particularly vulnerable to a loss of this kind, since so much of therapeutics is based on suggestion. And the loss naturally leaves him and his patient poorer.
End.
I think there was a lot of wisdom and foresight in this 1955 article. Technology has advanced medicine without doubt, but a good history and physical exam remain the basis of good care. The explosion of medical technology has introduced many useless and expensive technologies as well as pure snake oil, in addition to the useful technology. Marketing directly to patients has made it more difficult for physicians to practice good medicine and avoid the use of treatments that look wonderful on television but are not in the patient's interest.
We have a lot of work to do, but I think that physicians still have the best interests of their patients in mind and are the only ones who can fix what has broken, even if we played a role in breaking it.
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