politics and practice based on mindfulness

Tuesday, March 24, 2009


Great new post on the Daily Beast about the shortage of hands-on, old-fashioned, family doctoring  ... alas this kind of thing was once performed by physicians who didn't need to feed their MRIs, and infusion centers with "customers". 

Fewer graduates today choose family medicine because PCPs are forced by insurers to sandwich patient after patient into bologna-thin slices of time, and they do it for far less reimbursement than their specialist and surgical colleagues.  Dr Abraham Verghese makes suggestions to remedy the problem (quite easily) by creating a quid pro quo between new PCPs requiring scholarship debt relief and the government, which has a pressing need for a "physician corps" to practice in rural and underserved areas.  

Question for the day: has the mechanized care model won our hearts and minds so much that we will refuse to consider Dr. Verghese 's simple, effective proposal ... only because it promotes an archaic style of care?  

Some of my friends have had unnecessary MRIs.  I wonder whether the choice was made heedlessly, because of underlying anxiety that might have been addressed by a truly "attending" physician.  

And I have had one (perhaps) unneeded and very expensive biopsy, so I have to make some adaptations, too.  If my OB-GYN had had the time to call me before the decision was made with the surgeon, my choice might have been different.  Indeed she tried, but by then it was too late, and it's nearly always impossible to reach her by phone to return calls.  The choice of tight scheduling is not hers to make.  I'm sure she'd like to be more available. 

To create change, there has to be a will to wean ourselves off the fantasies surrounding high-tech care: that these procedures provide certainty in diagnosis (not always) and cost effective care (not necessarily).  

We can all agree that regular screening is a boon for many conditions.  But being sliced and diced into films, slides, and images is not equivalent to receiving good medical attention.  As a nation, we need the political will to keep private insurers who profit from high tech as far away as possible from the design of the new system.  One economist described the market effects of insurers' competition in healthcare:  "Competition can sometimes fragment value ... and even destroy it."

Final word today from the good doctor:

"Health reform must take away the incentives to do to and replace them with incentives to do for the patient and to be with the patient.  As the debate heats up and the lobbyists warm to their tasks, let's listen to the patients, because they can tell us what's wrong.  Yes they can."