Must we wait for health-care improvements?
BY MICHAEL MAXWELL
Thursday, January 31, 2013
1/31/13 at 4:41 AM
Why can't I get a simple antibiotic for my sinus infection? Why did that medical assistant give me a flu shot before I saw the doctor? Why did the doctor talk to me so long about a PSA test - I thought it was a simple blood test? Why are there so many physician assistants - I just want to see my doctor? Why doesn't my doctor see me in the hospital any more?
Change is happening in health care - and it's about time. Gone are the days when the friendly face at the doctor's office window remembered you by name. As patients we now feel lucky when our name pops up on the computer and we don't have to fill out more paperwork.
The poor quality of care in our state has been well publicized. While there are pockets of excellence in our region, you don't have to drive far in any direction to find problems rivaling those of Third World countries.
We've come from small group physician offices to large primary care and specialty groups. Medical groups were initially formed to reduce overhead costs through group purchasing. We are now seeing medical groups leverage their size to advance improvement in care.
We've moved from a culture of "profession-based care" through "evidence-based care" and are moving into an era of "systems-based care."
Health-care systems are designed around both the needs of the individual patient and the populations of patients. We've moved from expectations of one doctor knowing all and providing all of a patient's care to the position of the doctor quarterbacking a team of caregivers.
We are now calling that team the "patient-centered medical home," the "medical home" being the place where we as patients are well known and our values and needs are at the center of care.
We've moved from a time when physicians' advice to their patients was taken as unquestioned truth to an era when patients and physicians alike are deluged by too much information; finding the truth is both delicate and painstaking. Dr. Oz and the Internet don't always have it right.
We've moved from a time when there were no considerations given to the cost of care (the time frame in which most of our middle-aged and older physicians were trained) to our current time when we know that without meaningful change, the current method of health-care delivery will bankrupt an already financially struggling country.
For many physicians and patients, change is agonizingly disruptive. For many of us though there has never been a more exciting time to be in the profession of medicine.
We are moving into an era of cleansing. Backed by unprecedented science and technology and a growing spirit of collaboration, we are beginning to identify care that is wasteful and promote the care that is effective. We are doing the work that matters.
Physicians are not traveling this road alone. Unknown to most people in Tulsa is a program launched last October called The Comprehensive Primary Care Initiative, funded by Blue Cross Blue Shield, Community Care, Medicaid and Medicare.
Tulsa is one of seven regions in the country included in this program designed to advance the quality of primary health care while at the same time reducing costs. Seventy offices across the Tulsa region are participating. The greatest challenge moving forward will be how effective we are in working together - patients, physicians and health-care administrators.
Change is tough but this is work that matters to each of us. In a recent Oklahoma Center for Healthcare Improvement board of directors meeting, the man I consider my mentor and a visionary for health care said, "...real change is not likely to happen until a new generation of physicians comes in." Must we wait?
Michael Maxwell, M.D., FACP, is an internist in the OMNI Medical Group in Tulsa.
Michael Maxwell: We are beginning to identify care that is wasteful and promote the care that is effective. We are doing the work that matters