Health Care Reform

Young and optimistic, this chief resident at Swedish Family Medicine Residency, Denver, Colo., describes her vision of how healthcare now demands more partnerships and community point of view.

David B. Nash, MD, MBA, the Dr Raymond C. and Doris N. Grandon Professor of Health Policy and founding dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, provides an expert’s perspective on 2 issues in the current health care debate that are of particular concern to PCPs.

Hear an interview with Ted Rosen, MD, professor of dermatology at Baylor College of Medicine, and chief of Dermatology Service at Veterans Affairs Medical Center, Houston. Dr Rosen has a keen interest in current healthcare reform; he recently attended a summit in Washington with a group of think-tank leaders who are at the forefront of reform efforts.

Internal medicine doctors train predominantly in our high-tech academic medical centers, yet most will provide outpatient care. Here, Dr Andrew-Morris Singer frames one of modern healthcare’s greatest disconnects.

Recently, my wife and I received a gift certificate for one of our favorite restaurants, and we wasted no time in using it. The food and conversation were delightful, and the meal turned out to be exciting and enlightening on many levels. A patron of the restaurant, who was celebrating his 55th wedding anniversary, sustained a witnessed, public cardiac arrest. The experience led to an analysis of my involvement in the resuscitation.

Looking at contemporary medicine’s complex landscape, especially in regard to soaring costs, can make practitioners dizzy. For example, if primary care physicians were asked whether it is cost-efficient and reasonable to screen with prostate-specific antigen (PSA) measurement for early-stage prostate cancer in men with terminal pancreatic cancer or to perform colonoscopy for early diagnosis of colon cancer in women with stage IV lung cancer, the answer would be a quick and uniform no. Unfortunately, a recent publication suggests that in the real world the answer has been yes, as disturbing and wasteful as that may be.

Since continuing technological advancements are going to add to rising costs (dialysis, for example, with more “baby boomers” coming of Medicare age), one has to wonder what the something is that “has to give” in the future.

We live in a litigious society. Unfortunately, that statement may be most accurate in the setting of medical practice. Did you know that 40% and 34% of family practice and general internists, respectively, have been sued for malpractice? One in seven primary care practitioners have been sued at least twice. A recent "Business of Medicine Report" offered some very helpful advice that may keep practitioners out of court.