Writing in the latest issue of JAMA, Drs. Erica Spatz and Cary Gross of Yale's Robert Wood Johnson Clinical Scholars Program share their insights on the immediate and concrete steps that physicians can take to improve the health care system.They also unwittingly demonstrate the atrophy of higher order cognitive brain functions that result from the reality deprivation that afflicts many of our finest medical schools. Non-inhabitants of the academosphere that read JAMA may think these bright docs speak for the avant-garde of the mainstream physician community. That would be a mistake and would only make the Disease Management Care Blog's migraine worse.
The Disease Management Care Blog summarizes Drs Spatz's and Gross' suggestions below.
1. Work Daily to Provide High Quality Care - physicians should adopt 'new approaches' to measuring and improving quality of care.
2. Control Costs - physicians can act locally/think globally and 'consider' the costs of medications, tests and treatments.
3. Improve Communication - this can be achieved via electronic records, information exchange systems. giving lists to patients and 'shared decision making.'
4. Become Involved Locally - physicians should get involved or even volunteer in 'community based programs.'
5. Help Implement Creative Payment Reform Solutions - the 'several testable options' underway for control costs and increasing quality cry out for physician participation.
6. Talk About Reform With Patients - patients trust physicians to give them the insights they need about 'why change is needed.'
7. Minimize Conflicts of Interest - with the 'pharmaceutical' industry.
While the DMCB agrees with the technical merits of each of these seven points, they are astonishing for their their emphasis on the traditional role of the physician that still continues to be perpetuated by an unresponsive medical education system. Maybe the folks at Yale haven't heard about the emerging consensus on teaming, health consumerism, systems of care, increasing complexity of insurance designs, growing sense of alarm over health care costs, novel approaches to physician reimbursement, coming heavy-handed involvement of the U.S. government and work that remains in making health information technology useful.
The Disease Management Care Blog summarizes Drs Spatz's and Gross' suggestions below.
1. Work Daily to Provide High Quality Care - physicians should adopt 'new approaches' to measuring and improving quality of care.
2. Control Costs - physicians can act locally/think globally and 'consider' the costs of medications, tests and treatments.
3. Improve Communication - this can be achieved via electronic records, information exchange systems. giving lists to patients and 'shared decision making.'
4. Become Involved Locally - physicians should get involved or even volunteer in 'community based programs.'
5. Help Implement Creative Payment Reform Solutions - the 'several testable options' underway for control costs and increasing quality cry out for physician participation.
6. Talk About Reform With Patients - patients trust physicians to give them the insights they need about 'why change is needed.'
7. Minimize Conflicts of Interest - with the 'pharmaceutical' industry.
While the DMCB agrees with the technical merits of each of these seven points, they are astonishing for their their emphasis on the traditional role of the physician that still continues to be perpetuated by an unresponsive medical education system. Maybe the folks at Yale haven't heard about the emerging consensus on teaming, health consumerism, systems of care, increasing complexity of insurance designs, growing sense of alarm over health care costs, novel approaches to physician reimbursement, coming heavy-handed involvement of the U.S. government and work that remains in making health information technology useful.
The DMCB wishes that JAMA's editors had demanded more on behalf of their physician readers.
Anyone paying minimum attention to what is going on in health reform knows there is far more to the story at the bedside, the clinic and the community:
1. Work Daily to Provide High Quality Care - like it or not, physicians need to adapt now to new expectations and changing work roles that increase the delivery of high value. For example, they need to become experts in optimizing local work flows and the 'systemness' of leading non-physicians in ways that help their assigned patients maximize self-care.
2. Control Costs - physicians need to be responsible for helping patients and insurers navigate through increasingly complex insurance benefit designs with increased out of pocket costs. For example, they need to demand that HIT decision support also helps patients make decisions about care options that are aligned with their personal values and their pocket books.
1. Work Daily to Provide High Quality Care - like it or not, physicians need to adapt now to new expectations and changing work roles that increase the delivery of high value. For example, they need to become experts in optimizing local work flows and the 'systemness' of leading non-physicians in ways that help their assigned patients maximize self-care.
2. Control Costs - physicians need to be responsible for helping patients and insurers navigate through increasingly complex insurance benefit designs with increased out of pocket costs. For example, they need to demand that HIT decision support also helps patients make decisions about care options that are aligned with their personal values and their pocket books.
3. Improve Communication - this can be achieved not only via electronic records, information exchange systems, giving lists to patients and 'shared decision making,' but through web-based and 'push' cell phone technologies, support of personal health records and better coordination with resources that include, but are not limited to, insurers and community groups.
4. Become Involved Locally - physicians should not only get involved or volunteer in 'community based programs,' but communicate with their elected representatives, join at least one organized medicine group (there are options that range from the AMA to PNHP to PSR), write letters to the editor and serve in one or more advocacy groups - and that's just for starters.
5. Help Implement Creative Payment Reform Solutions - physicians need to be highly skeptical that any of the pilots and demos will be enough to reconcile escalating health care costs, limitless demand and ballooning government deficits. If there are any good ideas out there, now is the time to talk about them.
6. Talk About Reform With Patients - it's time for physicians to trust and listen to their patients so that they can gain better insights about 'why change is needed' and how to make it happen
7. Minimize Conflicts of Interest - physicians need to decide which is worse: the appearance of being fixated on preserving income while being played like puppets on a string by a government incapable of fixing the Sustainable Growth Rate, or, taking a huge cut in income that is likely to occur sooner or later anyway while preserving our self respect. Right now, the DMCB can't tell which is worse for the profession.
4. Become Involved Locally - physicians should not only get involved or volunteer in 'community based programs,' but communicate with their elected representatives, join at least one organized medicine group (there are options that range from the AMA to PNHP to PSR), write letters to the editor and serve in one or more advocacy groups - and that's just for starters.
5. Help Implement Creative Payment Reform Solutions - physicians need to be highly skeptical that any of the pilots and demos will be enough to reconcile escalating health care costs, limitless demand and ballooning government deficits. If there are any good ideas out there, now is the time to talk about them.
6. Talk About Reform With Patients - it's time for physicians to trust and listen to their patients so that they can gain better insights about 'why change is needed' and how to make it happen
7. Minimize Conflicts of Interest - physicians need to decide which is worse: the appearance of being fixated on preserving income while being played like puppets on a string by a government incapable of fixing the Sustainable Growth Rate, or, taking a huge cut in income that is likely to occur sooner or later anyway while preserving our self respect. Right now, the DMCB can't tell which is worse for the profession.
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