In recent years, we have seen a tremendous increase in the accuracy of medical diagnoses. As a compelling example, I propose the diagnosis given by the best doctors in our country regarding what ails our health care system. Seasoned veterans of outpatient clinics, emergency rooms, intensive care units, hospital wards, and operating rooms have focused their finely honed diagnostic acumen on themselves, their colleagues, and the system in which they practice. In this context, the saying, “doctor, heal yourself” has never been deeper. They have posted their authoritative reviews and recommendations for all to read.
On Battered: why we think we are getting good medical care and why we are generally wrong, Dr. Robert Pearl, former CEO of The Permanente Medical Group and a member of the faculties of Stanford Medical and Business Schools, draws on his personal experiences and a variety of highly relevant scientific findings to expose the many serious flaws in the way we provide healthcare to our citizens. On Carefree: How Medicine Culture Kills Doctors and Patients, this insightful plastic surgeon explains how physicians’ inherently large reservoir of empathy is systematically drained by a culture that has lost sight of the critical importance of this highly valued attribute.
On Broken, Bankrupt, and Dying: How to Solve the Great American Healthcare ScamDr. Brad Spellberg, medical director of the Los Angeles County Medical Center-University of Southern California, lays out the economics of healthcare in terms anyone can understand as he peppers his narrative with poignant vignettes drawn from years of caring for children. disadvantaged. His assessment is irrefutable: Compared to citizens of other developed countries, Americans are being scammed by the profiteers of the medical-industrial complex.
On Adulterated: An American Physician’s Disillusionment, Dr. Sandeep Jauhar, a cardiologist, explains how the root cause of medical burnout is simply the realization that one is working in a broken, unfair and impersonal system.
Like Dr. Jauhar, I have suffered from the symptoms of burnout. Like Dr. Spellberg, I have worked in a large public hospital in California. During my nearly 30 years of neurology practice at Santa Clara Valley Medical Center, in the heart of Silicon Valley and just 20 minutes down the Stanford Freeway, I too have witnessed the tragic and maddening consequences of losing health insurance when more is needed. or having inadequate access to appropriate preventive health care until an emergency arises. Like Dr. Perla, I have seen what happens when doctors, despite being motivated by the desire to help, cause harm by falling under the spell of false hope, promoted by a medical-industrial complex that seeks to maximize profits, and enthusiastically welcomed by a resourceful audience.
An ideal health care system would present a determined commitment to these three fundamental virtues: compassionate and uninterrupted care for all, rigorous scientific standards, and cost effectiveness. The cruel arbitrariness of a world where health coverage for oneself and one’s family is subject to the vagaries of one’s employment situation is incompatible with the first virtue. A fee-for-service payment model, integrated into a for-profit medical-industrial complex, is incompatible with the second and third virtues. Imagine a system comprising only nonprofit healthcare organizations employing a capitated payment model (global budget), contracting with the government to serve all citizens at all times, regardless of their employment or health status.
As a prototype of the type of healthcare delivery network found in an ideal national healthcare system, let me propose Kaiser Permanente, a highly successful nonprofit healthcare organization that operates 39 hospitals and more than 700 doctor’s offices. in eight states and employs more than 80,000 doctors and nurses. Kaiser Permanente’s pay-per-capitation model allows you to put cost-effective, evidence-based healthcare front and center as your top priority. Among the many fruits of this model is an alignment of incentives to optimize the use of telemedicine, information technology and an integrated electronic medical record, allowing Kaiser, in this regard, to leave its customers in the dust. fee-for-service competitors.
The US government, by hiring a number of entities similar to Kaiser, competing with each other to provide the best care in the most efficient manner, while sharing best practices, would put the American healthcare system first. among developed countries, from its current position as it also ran. Furthermore, in the absence of such a transformation, American healthcare is destined to fall further and further behind countries that have adopted, or are in the process of adopting, an integrated, evidence-based, universal health care system. Resistance to transformation is formidable and therefore change must be driven from within. Success depends on leading physicians convincing their colleagues and their patients that the path to wellness requires an elixir that, for many, tastes bitter and is sometimes painful to swallow.
The diagnosis is well established. A cure is within our grasp, and the wisest among our practitioners of the healing arts are offering valuable advice. When the United States government and science, at its most principled, work together, insulated from an insidious and unfair profit culture, they can land a man on the moon and launch a helicopter to Mars. They can also provide better healthcare in a much more equitable and cost-effective way. It is time for the patient to listen to her best doctors. They are giving it to you directly.
Jeffrey Fraser He is a neurologist.
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