rather than analysis dictates the truly important rules for identifying
the future as against the past;
on opportunity rather than on problem;
our own direction – rather than climb on the bandwagon;
high, aim for something that will make a difference, rather than for something
" "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
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
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.
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
in pricing and outcomes
Expanding catastrophic coverage,
insurance portable across state lines and from job to job
reform nationally with the introduction of
such things as tort courts to judge claims objectively and consideration of “loser
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.
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.
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.
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.
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.
medicine is the future. Primary care
physicians, using software, can offer effective, sophisticated, personal care
in the office setting.
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