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Saturday, December 5, 2009

How the conference on affordable health care went

There were nearly 30 people there, at a not much more than 40 bed hospital. This is unprecedented for a not-required noon meeting. There was food, but it wasn’t very good, so they were there for the content (or maybe they though the food would be better.)

The radiologist talked about appropriate use of technology and reducing unnecessary testing. Primary care docs talked about ways to make the computerized medical record systems give information about costs. The pharmacist talked about how to find out good information about drug costs, and we discussed ways to educate docs in the hospital on alternatives to the most expensive medications. We discussed other methods for reducing pharmacy costs which will also have other health benefits (changing medications given by vein to ones given by mouth, for instance.) The hospital CEO was willing to commit to putting into practice a system that would promote cost transparency for providers and patients. We talked about shifting responsibilities for record keeping to nurses in our offices so we would have more time to see patients so they wouldn’t have to go to emergency rooms where the costs are higher and the care is less personalized.

What will come of this is unclear, but the very act of discussing it in an open forum is brand new in my experience.

There is a part in the hippocratic oath about sharing the precepts and learning only with those who have taken the sacred oaths and the sons of other doctors. This may partially underlie a tendency of doctors to be circumspect. For whatever reason the workings of the practice of medicine are not shared easily outside of the profession. Discussing and re-evaluating what we do will go against some pretty basic instincts.

Post conference feedback has been interesting too. As might be imagined, not everybody had their say, and not everybody's issue got discussed. One provider mentioned that she would have liked to problem solve some really pressing issues of access to care. A tech guy mentioned that he had lots of ideas on how to make the hospital staff more efficient by making technology more effective. I am sure that the more we talk, the more issues will come up, and there may need to be smaller conversations and groups of people with similar interests will have to do their own work.

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