Posts Tagged ‘ethics’

Is the Primary Care Doctor Obsolete?

Sunday, October 16th, 2011

During the Great Depression, we had a family doctor who was a general practitioner. He took care of adults, delivered babies, took care of them as well as their brothers and sisters, set bones, and did surgery. Today, family doctors are usually board-certified family or internal medicine specialists who do not deliver babies nor do surgery. They are regarded as “primary care doctors.”

Primary care doctors are the first ones the patient should consult regarding their medical concerns. That doctor is the first to assess their problems and manage their medical care.  For primary care doctors, the patient is at the center of care. This may seem obvious, but many doctors no longer do this. They focus on the disease and its treatment, often ignoring the personal needs of the patient.

Today, many regard medical care as the applied science of statistically derived, evidence-based medicine based upon practices shown to be effective for the majority of a group. They treat the individual as a statistical integer in a group or herd, and not as a person.

Medical care should be more than individual care. It should be personal care. Individual care defines a person in terms of measureable characteristics such as age, weight, height, blood pressure, blood tests for sugar, cholesterol, hemoglobin and many others tests such as genetic makeup, to name a few.

Personal care, on the other hand, includes not only measureable characteristics, but other factors that lend themselves less readily to measurement, such as cultural background, education, training, likes, dislikes, view of health and disease, and other biases. These factors have been proven to have a significant impact upon the effectiveness of disease management. They’re mostly ignored in herd care.

I want to emphasize that personal medical care should not be confused with personal-ized medical care, a term hijacked by geneticists and deceptively used starting 10 years ago. This genome-based care focuses on genetic markers to target diseases and care methods, such as susceptibility to certain drug treatments. This alone may help provide more precise individual care, but it is no more personal than a fingerprint.

Primary care physicians are the ones who traditionally focus on personal care.   Health systems that incorporate the primary care physician as a central part of treatment have better outcomes at lower cost than those systems without them.  

Despite the obvious advantages of using primary care doctors, they are in danger of becoming obsolete. They are the victims of a medical system that now largely focuses on costly technology in the treatment of disease.

The challenge today is to return the primary care doctor to the center of patient care.

Norman Makous, M.D.

[ Excerpted from the article, “Is the Primary Care Doctor Obsolete?” by Norman Makous, M.D. Follow this link to view the complete article. ]

Rationing in the Health Care Reform Bill

Tuesday, December 1st, 2009

Most of the attention directed to the Affordable Health Care for America Act is concentrated on the provisions for the extension of health insurance coverage to a greater proportion of the population. Those provisions that reduce Medicare coverage for seniors are interpreted as “rationing” and pointed to with horror. The other significant aspects of rationing addressed in the bill are largely ignored.

Among these is the provision that health care benefits will be chosen by a Health Care Commissioner and by a government committee.  This will include benefit levels for private plans. How can this be done in order to be just and equitable and not based on cost savings alone? That’s the question on which public attention should be focused.

Instead of continuing to deny that we have had and still have rationing, and that it must continue, the necessity for rationing should be admitted.  The mechanisms must be closely scrutinized to help insure that they are just and subject to the least amount of lobbying and for-profit abuse.

The rationing system must not be left to politicians, bureaucrats and insurance company executives. Public values must control our methods of rationing.

Norman Makous, M.D.

What We Need Now Is True Medical Care Reform

Sunday, November 8th, 2009

The current health care reform legislation is, more precisely, health coverage reform. The intention is to cover more people through changes in the health insurance system. It will do little to control costs. In fact, the cost of the legislation will be much higher than touted.

The problem that has not been touched in the current legislation relates to how we provide medical services. The main driver of increases in medical costs is our technology-based medical service system. This causes an economic squeeze in health care that has already required rationing of medical services. Even with health insurance reform, the cost of medical care will continue to rise, and the need for rationing will increase. (more…)

The Assault on Medical Professionalism

Saturday, October 10th, 2009

Medical care is not a trade.  The professional commitment required is more than simply a calling to a discipline. It involves ethical conduct that recognizes the contract between the patient and the physician. The welfare of the patient always takes precedence over the doctor’s self interest.

Most people have turned their medical care purse over to third parties, who now negotiate with the doctor over care.  These insurers and managed care entities pressure the doctor to act as “gate keeper” and ration the patient’s care in ways that may not be in the patient’s best interest.  Doctors have a conflict of interest and are placed in an unethical position.

Doctors still interested in doing things in the best interest of their patients are concerned about the poor quality of care. The third parties blame the doctors.

Caveat Patiens.” Patient, beware. An increasing number of doctors have succumbed to turning medical care into a business for profit.

The third parties have wrested control of medical care from the physician community and turned medicine into a free market commodity. This is an assault on medical professionalism and independence.