Continuing the discussion on the Healthcare reform process, over the last few months I have heard various sides of the debate, from my physician colleagues in radiology and other subspecialties to scores of testimonials from patients, friends and family. I have also read numerous articles on the potential effects of the proposed plans and listened to the "experts" on TV and radio panel discussions.
Despite this, however, the healthcare reform proposals are still not clear to me and seem to be swayed by political posturing from every side of this extremely complex issue. Healthcare reform, if and how it is enacted, will touch our sense of well-being. It will affect how we deal with the inevitable questions of life including quality of life, morbidity and death. It will ultimately touch everyone.
That being said, when I listen to the direction of the proposed policies, the special interest groups and their lobbyists and the "deals" being formulated to get the task accomplished, I cannot help but think that the reform bill is forgetting the underlying problem and the need for reform.
The conversations regarding the reform proposals should not focus only on who is making too much money or who is not making enough, or who (other than the patient) stands to gain or lose. This divisive focus is resulting in physician vs. surgeon vs. primary care physicians vs. the specialty physicians as well pharmaceutical companies vs. insurance companies. The list of X vs. Y goes on and on. This is where these conversations and proposals and "deals" seem to be missing the point.
Reform should focus on the patient and what we (and by we I mean all healthcare providers, the private sector including insurance companies and the government ) can do to ensure the best in quality patient care for most, if not all of our population.
All patients, no matter what socioeconomic status, should have ease of access to expert care for diagnosis, medical tests and examinations, therapeutic treatments and medication. Patients' signs and symptoms as well as history of concerns need to be assessed carefully and thoroughly. Lab studies, imaging, physical therapy, interventions, etc. should follow a carefully and expertly conducted history and physical examination. Most importantly, the testing, including examinations and imaging, should be ordered with a definitive thought process around what is being looked for. Examinations and tests should be ordered with the understanding of how the ultimate results will alter the chosen therapy. There must be validated competencies that the tests are going to be accurately performed and interpreted and an accreditation process that will prevent the results from being scrutinized for validity or accuracy.
Some of the questions I ask about any proposal that is presented to the American public include:
Will treatment options be carefully determined based on the findings or will they be what is expeditious and most beneficial to the practice?
Will the orders for medications, tests and treatment be considered routine and standard of care (e.g., Take two aspirin and call me in the morning) or will the "next steps" be specific to the patient's clinical presentation?
Will the treatment options be available and cost effective for the practice, the patient and healthcare in general?
These are the questions that most concern me and I hope that they will be considered in the ultimate healthcare reform bill.