Dr. Brent James Could Be Health Care's Saving Grace

New York Times:

The health care debate of 2009 has had so many moving parts that it has sometimes seemed impossible to follow. The crisis behind the debate, though, is about one thing above all: the scattershot nature of American medicine. The fee-for-service payment system -- combined with our own instincts as patients -- encourages ever more testing and treatments. We're not sure which ones make a difference, but we keep on getting them, and costs keep rising.

Any bill that Congress passes this year is unlikely to fix these problems. The lobbying groups for drug companies, device makers, insurers, doctors and hospitals have succeeded, so far, in keeping big, systemic changes out of the bills. And yet the modern history of medicine -- the story that James tells -- nonetheless offers reason for optimism. Medicine has changed before, after all. When it did, government policy played a role. But much of the impetus came from inside the profession. Doctors helped change other doctors.

Read the whole story: New York Times

Comments

[danielet]

Primary care used to be done by a "general practitioner" with only one year of post-graduation internship. His job was merely to direct patients to specialists. The "internist" with three-and-a-half years of residency was the prince of healthcare because his job was to coordinate the advice of each specialist about his favorite organ, based on the internist's knowledge of the WHOLE patient. Now the latter has been reduced to to the status of the former who disappeared. Furthermore, the Institute of Medicine will establish "best practices" based on the self-serving data provided by Pharma, device makers and hospitals. While internists forced to diagnose and treat each patient in only minutes will feel relieved of liability by best practices, the insurers will soon conclude that nurse practitioner or physician's assistance can follow the Institute of Medicine's "best practice" algorithms more cheaply than the internist. As a result, the revolution in individualized epigenetic medicine will be set aside as mediicne becomes a one-size-fits-all paradigm a la 1950s. The Obama plan thus throws healthcare backwards, not forward into the scientific revolution where we need to be; all patients will be treated statistically rather than individually. Pay internists to study molecular medicine so they can treat patients as individuals, not like lab rats, updating internists on the science, not just the art of medicine, making healthcare cheaper and more effective.