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Wednesday, March 2, 2011

Practicing good medicine by paying attention to the patient

I just read an article in the New England Journal of Medicine by Sean Palfrey MD, a professor at Boston University School of Medicine in the department of pediatrics.  Dr. Palfrey dares to state the obvious, in a world in which the telling it like it is can be the kiss of death.  Dr. Palfrey writes:

Every participant in our health care system must focus on ways to optimize health while decreasing cost, at every step of the process. We need to change the financial incentives currently embedded in health care reimbursement systems that reward the use of tests, procedures, consultations, and high-cost therapies. And finally, the legal system needs to be more restrained about pursuing lawsuits when a difficult diagnosis is missed or a treatment fails, to diminish the pressure on health care providers to practice expensive, defensive medicine at every turn.
These are major changes, but today we are far from providing good care for all our citizens and far from achieving health care equal to that in many other countries. We need to incorporate more realistic clinical, scientific, and financial information into practice in order to bring our health care practices, and our health care system, back into balance.
Thank you, Dr. Palfrey. The reason that this opinion is so unpopular among politicians is that it brings up the specter of doctors mistreating or ignoring the suffering of patients in order to save a buck. This is an issue that must be recognized and dealt with in an era when practicing cost effective medicine will be the only practical path. Good medicine and attention to costs can go hand in hand if the physician truly takes the time to listen to the patient and think about the diagnosis. Further, inexperienced doctors need to be able to use the wisdom of experienced colleagues, either by formal or by informal consultation, which requires time and good communication. In many cases, the approach that involves more testing, more complexity and more treatments saves a little bit of time in the short run, wastes a whole lot of money, and leads to more time wasted and poorer patient care in the end.


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