Friday, February 21, 2014

The Effective Physician

Courage rather than analysis dictates the truly important rules for identifying priorities;
       Pick the future as against the past;

·         Focus on opportunity rather than on problem;

·         Choose our own direction – rather than climb on the bandwagon;

·         Aim high, aim for something that will make a difference, rather than for something that is  
"  "safe” and “easy to do.”

Peter Drucker,  The Effective Executive, 1966-1967, Harper & Row

I have been invited to give a talk before the American Association of Physician Executives (AAPS).   Some  consider AAPS to be an overly conservative, even a right wing,  organization.       I do not.

AAPS advocates direct pay medicine, abandoning 3rd parties, being available 24/7 with patients, seeing patients on the day they call, and spending unlimited time with patients – all for either direct pay at the time at the time of service or on the basis of a monthly or yearly retainer.   

This  approach strikes some as a return to the status quo, as going back to the way it used to be, as Neanderthal Medicine.   Others consider it the antithesis of  progressive health care – an antidote to ObamaCare.

I do not agree with the naysayers. To me, it represents a return to patient-centered medicine and personalized care.   It represent the future,  a focus on the patient rather than a focus on organization or government.  
 It represents an opportunity to put a new face on medicine,  personal care rather than government care.  It represents a chance  create a new bandwagon in an evolving two tier system, one tier dominated by  government (Medicare, Medicaid,  and  large managed organizations, and the other by physicians  as individuals or as members of a team offering personal care.

When  preparing for the talk,  I asked my son, Spencer, an Episcopal priest and a nationally known poet,  how to present my talk without using notes.    He said , “Dad, use an acronym. Keep it in your head.  I use acronyms in my  homilies."


My acronym is FOBB (Future. Opportunity,  Bandwagon,  and Big).  I believe the Future lies in offering patients more personal service in the form of time spent with them.  I believe  the Opportunity  to ride the new physician Bandwagon  is to create new ways of doing  this efficiently and effectively using  IT (information technologies).   And I believe  this can only be done by  thinking about Big national health reform.  Offering  sensible alternativse to  ObamaCare  is  badly needed, not only as an alternative ot ObamaCare but as an alternative to the old way of practicing. 

Positive Sensible Alternatives

As  physicians,  we must present a positive , sensible alternative alternatives  to ObamaCare.    This is the only way centrist conservative Americans  can win elections .  
As things stand right now,  the odds  are Democrats will lose both the House and the Senate, and Republicans will have the opportunity to change  Obamacare and to bring their alternatives to the Senate floor for votes.  
 I believe these alternatives should include:  

·         Tax credits for health care spending for all Americans, individuals  as well as corporation;

·         Pooling of risks for small businesses and individuals to keep premiums low

·          Transparency in pricing and  outcomes 

·         Expanding catastrophic  coverage,

·          Making insurance portable across state lines and from job to job

·          Tort reform nationally  with the introduction of such things as tort courts to judge claims objectively and consideration of “loser pays” policies;

·          Expansion of health savings accounts by employers to shift responsibility for decision making to patients and their doctors

·           And last, and foremost,    better use of broadband technologies to make medical care more effective.

Accurate Diagnostic, Prognostic, and Wellness Evaluation in the Office

 I believe it is possible for primary care physicians  in their office  to give an accurate diagnostic, prognostic, and wellness evaluation using IT.   The technologies are there, they exist,  and they are available.     

They include:

·         The instant medical  history, wherein patients enter their chief complaint, demographic information,  clinical symptoms via their home computer or a laptop in the reception room.

·           computer differential diagnosis software programs based on the history and laboratory and other tests.

·          HQ (Health Quotient),  normal range 80 to 120,  based on physical and vital sign measurements and laboratory tests, comparing them to their peers.

·         Where appropriate, cardiopulmonary evaluation and cancer software progams   using systems that comparing data to outcomes of thousands of patients and preceded them and whose outcomes are known.

A software program can integrate this information and the patient can leave the office with a documented record of their diagnostic, prognostic, and wellness status.  Patients are concerned not only about  their disease but their health as well, and what to do about each.

Tweet:   Personalized medicine is the future.  Primary care physicians, using software, can offer effective, sophisticated, personal care in the office setting.

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