Tuesday, December 8, 2009

Doctor Shortage - The Good News is the Bad News about Practicing Doctors is Wrong

The publisher of HealthNewsDigest.com has invited me to write a 1500 word forecast for physicians. The publisher says,

HealthNewsDigest.com is a 10-year-old online magazine that publishes news stories on the health industry 24/7. We are the premier electronic health news network and the No. 1 provider of health news content. We are syndicated to thousands of major health industry Web sites, content and applications to PDA, wireless PDA and smartphone users, and read in 162 countries. Also, over 2,000 news editors, directors and health columnists subscribe.”


I am tempted. Health care news online and through PDAs (personal data assistants) is the future. Electronic news is the fastest way to spread news. Online news may supplant print news. Kindle and Nook may replace books.

I would also like to explain some of the bad news is wrong about physicians, that they are routinely practicing defensive medicine, over-treating and over-diagnosing, ordering imaging in place of history taking and physical examination, ignoring health benefits of alternative medicines, spending too little time with patients, callously shunning miracles of information technologies, needlessly driving up costs, and not improving the health of Americans.

The good news about the bad news of declining health of Americans is wrong. Just yesterday the American Cancer society announced survival rates for lung, colon, prostate, and breast cancers are improving. Today two-thirds of cancer victims survive 5 years or more; several decades ago only one-third survived 5 years. American doctors have played a large role in lengthening those survival times.

A lot of the bad news about health care is either wrong or misguided, for example their sparse use of electronic health records. Physicians in general are technophiliacs. They love wireless electronic gadgets and their applications, computers with broad band access, Iphones, PDAs, GPSs. Many practicing doctors simply do not think EMRS are mature enough to be useful or user-friendly. As for their practice behaviors and patterns, doctors do tend to over-order to ward off malpractice suits. This is the fault of over litiginous climate, not of doctors.

Because of the physician shortage, offices are swamped with patients. Because of arbitrary and capricious Medicare and other third party cuts, they have to see more patients, with less time for each, to make ends meet. Furthermore, because most medicine is gray rather than black or white, doctors know most protocols and evidence-based guidelines are of limited usefulness in many patient encounters. And doctors know most alternative medicine treatments, though they have positive placebo effects, do not stand up under scientific scrutiny of controlled clinical trials.

The good news is that organizations like The Physicians’ Foundation are taking positive and rational steps to address the bad news. The Foundation has conducted a survey of 300,000 primary care physicians to assess the needs, wants, and plans; sponsored books on their feelings and the possible impacts of reform; financed a comprehensive study on how to address the physician shortage; and are engaged in organizing a physician leadership institute to respond to bad news and to improve care. The good news is doctors are not wedded to the status quo and have an open mind about adapting to the new realities.

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