Sunday, March 12, 2017

Modern Medicine: not Based on Individual MD's, but on Organizations Focused on Disease Prevention and Management

David Anderson, MD
David Anderson received his B.S. from Stanford and his medical degree from Johns Hopkins and his cardiology training at U.C. San Francisco. He is one of the pioneers in the field of coronary intervention. He helped to develop the program at Summit Medical Center that trained many of the cardiologists in the San Francisco Bay Area in the techniques of angioplasty, atherectomy and stenting. He practices at Stanford Health Care. 

David is a friend, and a great human being. The current assault on the Affordable Care Act has motivated him to formulate and write down his own thoughts about it.  He shared what follows in an email with friends. With his permission, I reproduce it here.  

David Anderson, MD: On Healthcare 2017

I am a doctor, a cardiologist to be specific. I have been in private practice for 35 years. As the “debate” on the ACA rages, can I share a few things about healthcare and health insurance, things that nobody seems to be talking about?

1)   Depriving people of access to affordable health care is very expensive: 

      It is more expensive for all of us to leave a large segment of the population without accessible affordable healthcare. Leaving aside issues of justice and empowerment there is the fact that if you cannot care for your health in an ongoing proactive way your healthcare becomes much more expensive. Take for example hypertension, a common easily identifiable problem that costs less than a dollar a day to treat. Left unidentified it will cause kidney failure, stroke, heart attack. The TYPICAL uninsured patient will show up in an ER in extremis, in need of say dialysis (which will be provided, by law). The patient will go on disability and be unemployed. He will live with family for a few years and then have a stroke or other catastrophe, and he will end up in a nursing home for more years. There are other scenarios, other diseases, all with the same message.  Here is the point, all this care is now, and will be, paid for by community institutions and healthcare providers and all existing and proposed government plans being put forth, one way or another. So I ask, if arguments of humanity are not convincing-what about plain old fashioned (conservative) principles, such as efficiency,  or everyone paying to their ability,  or cost effectiveness,  or preventative maintenance?

2)    Modern medicine is not structured on individual MD's:

      Healthcare has evolved from an enterprise based on episodic encounters between you and your doctor over isolated events of trauma or illness, into an enterprise based on  organizations that are structured to provide broad-based and long-term disease prevention and management. This has proved to be highly effective. This type of organization based approach involves “best practices” credentialing panels, an electronic medical record and approved pharmacies, etc. It is a structure driven by medical leaders and doctors and has been embraced by payors. IT HAS NOTHING TO DO WITH THE GOVERNMENT, NO MATTER WHAT FORM OF PAYMENT IS DEVISED. The days of the individual MD practicing in isolation doing his best for you as he sees it, are over. THANK GOD.

3)   There is a broad consensus that organizations structured to provide disease prevention management that includes everyone--like the ACA attempts to do--is the correct approach:

      "Medical” voices in the Republican administration (think Tom Price) are eccentric to mainstream medical thought. They are stuck on a vision of the individual MD practicing in isolation trying to do his best for you. I would direct your attention to any number of the leading medical publications such as the New England Journal of Medicine who think this is a bad idea. I cannot help but make the analogy to the voices attempting to forestall climate change. Climate change denial and this outmoded view of medicine are part of the same anti-intellectualism; they are not the result of a well thought out critique--these are  specious critiques.  Our country has a tradition of embracing science, new thought, new direction, and running with it. To discount expert opinion because it is not expedient or does not fit into one’s worldview is dangerous, counter productive and leads to errant policy.

4)   The ACA is working:

      I practice in a variety of settings, urban, suburban, rich and poor and I see the positive effects of the ACA every day. My personal view is shared by the majority of medical practitioners and by the main industry associations (Am college of Physicians, Am Academy of Peds, Kaiser, Am Hospital Ass, Catholic Healthcare; just google “organizations in support of the ACA”) The system can and should be improved. The problem lays in the fact that so much time and money has been spent on just keeping it alive politically that there has been little energy left for the project of improving it. Likewise, the uncertainty has left many institutions watching and waiting rather than investing and developing. Given the political resistance it is amazing that the ACA has done as well as it has! Is the answer starting over??

Again, I know of what I speak. I have been in the trenches. We need to stand up for truth.

David J Anderson MD FACC

1 comment:

  1. Thank you, Dave, for speaking so clearly about this issue. I hope it is ok that I am sharing the article. LT