despite careful clinical trials, the outcomes of medical treatments are not
always what we expect. The Institute of Medicine reports that 100,000 deaths
per year occur from the right drug being used for the right reason in the right
person. These are not mistakes,
but consequences of our therapy. And research shows that long-accepted
procedures such as coronary artery stenting may not ultimately extend a
Based on this new data, should we say such treatments do not
work and therefore stop doing them and paying for them? These are the huge
questions created by unexpected evidence-based evaluations.
In order to fix
what is wrong, we have to make informed decisions rather than ones based on
fear and politics. As noted in this discussion, lifestyle and behavior choices
are key, and prevention is important for promoting health. But as a faculty
member at a primary-care-focused allopathic medical school, I can state that we
do not teach about health and healing. Instead, our focus is anti-infectious,
anti-hypertensive, anti-depressant, and so on.
We must recognize that times
have changed. Our tremendous successes in handling issues such as infectious
disease pale with our difficulty in managing chronic pain, depression, obesity,
and other epidemics of modern life.
healthcare system is not about health. We spend more per capita on healthcare
than any other country on earth, yet we're far down the list when it comes to patient
outcomes. Our current system of basing care on fee for service not only leaves
millions of Americans un- or under-insured (people rob banks in order to get
health care!). It also encourages physicians to "do something" -- to order more
tests and prescribe more pills -- even though more and more evidence shows that what we do may not be as important as how we do it.
When we had fewer things
that we could do, we focused on being present for our patients.
We need to find ways to do this again -- to provide care that focuses on each
person. All physicians must recognize what Hippocrates stated, that it is more
important to treat the person than the disease, as diseases manifest
differently in every person.
models are beginning to emerge. The patient centered medical home allows doctors
to organize their practices around their patients, creating a functional system
that is based on health and healing. Doctors must also make meaningful use of
electronic health records and delegate tasks to other members of the team,
allowing many of the necessary parts of patient care to occur online and even
after hours. This can free us up to focus more closely on our patients'
lifestyles and behaviors, their joys and sorrows, and address their most
important issues face-to-face.
In this, we can learn from complementary and
alternative providers, who recognize the value of good bedside manner and
individual attention. Patients and providers have trouble finding that in our