This is Jane Orient, MD, of Tucson, Arizona and head of Association of American Physicians and Surgeons, responding to the Cato report described here:
So just who should be my boss? What credentials? What oversight of the boss? Who gets sued if there's a problem?
The "project manager" in cases like Mr. Kling's used to be called "doctor." Seeing to all those details used to be my job when I was the attending internist rounding on my private patients in the hospital, calling the consultants but doing all the medical work outside of the specialty procedures, always looking for trouble. Continue reading Bossed to Death→
Treating a complex patient is comparable to building a house. The work of a number of skilled craftsmen needs to be planned and managed. When unexpected problems occur, someone needs to revise and adapt the plan. In constructing a house, that role is played by a general contractor.
[However, in medicine] it is as if the concrete contractor, the drywall contractor, the electrician, and the plumber all refuse to work under a general contractor. Instead, they each try to do their jobs independently, regardless of the impact on the rest of the project. No one craftsman is in a position to take responsibility for delivering the overall finished product, and quality suffers as a result.
[A] 19-point checklist…[including] basic safety measures, such as ensuring that patients get antibiotics to prevent infection and requiring that all members of the team introduce themselves…reduced the number of deaths from surgery by more than 40%.
Best way to lose weight: do it yourself.
More than half of successful dieters lose weight on their own…without the aid of a commercial diet program, medical treatment, book, or diet pills.
The $452 cost of genetic testing will always be a bargain compared with wasting tens of thousands of dollars giving drugs to people who have no chance of being helped.
Doctors have an ethical obligation to tell patients if they are more likely to survive, be cured, live longer or avoid complications by going to Hospital A instead of Hospital B. And that obligation holds even if the doctor happens to work at Hospital B, and revealing the truth might mean patients will take their business someplace else.
Not everyone agrees. [link] For the government's hospital quality data, go here.
Cost: $2,000 a year ($500 for a child). In return, you get 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals. In some cases, you get cell phone and e-mail access. “Concierge” or “boutique” doctors are stepping outside the insurance system and repackaging and repricing their services. Explains one doctor:
Traditional practice right now is totally geared toward the treatment of illness….. For those patients who want what the system does not offer, shouldn’t they be given the choice? When I know I am not managing your Type 2 diabetes because I only have 10 minutes and God forbid you end up blind or amputated as a result, something is wrong with the morality of that approach and the ethics.
In a study (unfortunately gated) published in the July/August issue of Health Affairs, Steven Pearson of Massachusetts General Hospital and coauthors evaluate the impact on quality of all P4P programs introduced into physician group contracts during 2001-2003 by the five major commercial health plans operating in Massachusetts. Overall, P4P contracts were not associated with greater improvement in quality compared to a rising secular trend.
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