Medical Care


Medical Education

Some Topics

Innovations in Medical Care

There are opportunities in every direction to improve the health of citizens and to improve their care when they are sick or injured. In a world of increasing online activity and big data there is a need for new information technologies in all aspects of medicine. A Vancouver initiative for example attempts to bring together smart people from many disciplines. They stated:” Health Technology Forum (HTF) is a platform for people worldwide who have a common interest in making healthcare better, more accessible and affordable. Our international network of technology and healthcare entrepreneurs, developers, regulators, and providers are advancing the pace of healthcare innovation by engaging in exciting and productive dialogue between experts in healthcare. Worldwide interconnections are critical as we think global and act local. The advent of PHRs, social network, open platforms, smartphone, personalized medicine, compliance, interoperability, and policies are creating new opportunities for everyone to engage in a dialog to improve care everywhere.”[i]

For many years, I have proposed a collaborative relationship between patient and physician. Medical information in books and on the internet gives every intelligent person access to a variety of options. Often a smart patient with a specific disease is better informed than the physician he or she consults. A well-informed patient has more time, higher motivation and greater vested interest than even the most concerned of physicians. The physician, however is the gatekeeper to medical resources and must be consulted, respected and encouraged to give the patient access to whatever information and help he or she requires. When a patient is too ill to negotiate, then a family member, friend or trusted professional advisor must act on his or her behalf. Every patient in hospital would in the best case have a trusted advocate close by

Sharing Information

A growing consensus among medical institutions is that improved sharing of information and collaboration among different specialties is needed. Payment for services must shift from procedure fee schedules toward payment for good outcomes. While good outcomes should be the focus of medical interventions, there are great obstacles. If an insurer becomes responsible for measuring outcomes and determines how to pay for the results, medical service providers may disagree with the details of outcome measurements and may need a reliable income to maintain all the costs of providing care. Self-responsibility becomes the key determinant of outcomes. The best judges of outcome are the patients and their families. When a patient is hospitalized, family and close advisors are needed to advocate the best treatment required and must monitor the care actually provided. When a patient is discharged form hospital or moves from one institution to another a patient advocate is required to ensure transfer of information and responsibility.

The move to value-based medicine, which includes measurements of patient outcomes, generates heated debate on the subject of patient adherence. Now that the USA Medicare Access and CHIP Reauthorization Act (MACRA) will tie doctors' reimbursement to quality metrics, including reports on patient outcomes, a growing number of doctors are angry about being held accountable for behavior that is beyond their control. Many respondents used analogies to illustrate the absurdity of holding physicians responsible for their patients' behavior. "Will I be able to hold the grocery store responsible for my bad cooking?" “All doctors should close their offices for the month of December—or rather, since most of us are now wage slaves, not show up to clock in and leave the ER patients to the administrators, and let the OR lights darken. Then, when we come back in January, if the public still doesn't appreciate what we do, we can take off January too." "The biggest problem with this whole discussion is that it focuses on medication-based treatment and outcomes rather than on the real causes of disease, which are the real determinants of outcome: lifestyle habits, including diet, activity, sleep, and stress resilience," a preventive medicine specialist asserted. [ii]

The prestigious New England Journal of Medicine often discusses “healthcare” delivery. In a new initiative, Catalyst, they discuss” Disconnects in Transforming Health Care Delivery. How Executives, Clinical Leaders, and Clinicians Must Bridge Their Divide and Move Forward Together.” Again the misnomer “healthcare’ distracts commentators from the real issues that involve hospitals, MDs and inadequate patient care. A key statement;” When it comes to care delivery, no two words have had a bigger ripple effect throughout the industry than “patient engagement.” Market share, reimbursements, population health, and more depend on the ability of health systems, hospitals, and physician organizations to get patients, as well as caregivers, invested in their health and care plans. To that end, many health care organizations have deployed patient portals, secure email, quality metrics, and more to entice patients into a more active role and to communicate in a more preventive and productive manner with their care teams. And this is where we encounter the first disconnect in Insights Council responses. A majority of clinical leaders (60%) believe patient engagement tools are having a major or moderate impact on quality outcomes. However, fewer than half of executives (47%) and clinicians (43%) agree. [iii]

[i] Accessed Online Feb 2016 http://www.meetup.com/HealthTechnologyForum-Vancouver/
[ii] Agnes Shanley. Shouldn't Patients Be More Responsible for Their Outcomes? Medscape December 15,2016
[iii] Accessed Online April 2017. www.catalyst.nejm.org


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