Search for tag: "health care reform"

The gospel that I am trying to preach is to my colleagues in medicine, understand what's happening, learn the facts, lift up your heads enough to see what's going on around you. Understand the problem and then begin to ask yourselves "What can I do to help?"

When I started out in medicine in 1946 there was no such thing as a health care industry. The term health care industry had never been used. Nobody referred to it as an industry and nobody thought that being a physician was a business. Now we are dealing with the inevitable consequences of a health care system, which changed from a social service to a business. Just as you would predict it ignores more or less those who can't afford to pay. It exploits the opportunities to make money at the expense of the obligation to use resources conservatively in the most effective, medically appropriate way.

It invites all sorts of abuses including fraud and it's clear that it's not working and it can't work because there's a fundamental disconnect between medical care and almost all other economic activities in our society. A patient consulting a physician because they're sick, got injured, worried, or frightened that they may die or become seriously ill is not like an ordinary consumer in an ordinary market and physicians should not be like vendors in an ordinary market. Their objective should not be simply to sell whatever the consumer will buy.

Physicians are in the best position to decide how best to use the resources that we expend on health care. I've outlined what doctors might do if they wanted to. They could form multi-specialty group practices not-for-profit group practices that would be prepared to accept payment on a per capita rather than on a piece work basis, on a per capita basis for comprehensive care. There's no question that that system would work.

The only question is, how do we get it to occur politically in the current political climate? That's a big problem, we're going to have to change the attitude of the public and we're going to have to change the attitude of the legislators. It's issue of survival. We are simply not going to survive with the health care system we have now. It's going to implode. We must do something and doctors could help get it started. At least that's my hope and I think it's not unreasonable.

One of the hopeful aspects of all of this is that pretty soon half of all practicing physicians are going to be women. More and more multi-specialty groups are being formed and women are becoming a very significant part of that movement. I'm expecting that women may save the day.

Some of the most innovative things that we're thinking about right now are something referred to as milestones. So in the residency world, we're being able to now identify exactly where people are along a spectrum of skills in six different areas and with the idea and vision that as people meet those skills we can move them along the pathway and again get rid of the rigid timelines that we're currently married to.

For those of us who have been doing medical education for a long time, we know some people learn faster than others, and other people learn slower. The fact that we're facing a deficit of 90,000 physicians coming up here very soon in the next decade, we really need to be thinking about: How can we turn people out more quickly? How can we ensure that we get people in the pipeline, keep them in the pipeline, and then turn them out at the end?

The thought that keeps me up at night is probably that we're not using people's time effectively. Not just individual people, but thinking about the synergy that gets created when we bring the right people together.

Our universities without the people, the faculty, the staff, the students are really just a collection of buildings and equipment and material supplies. The people who are there are the ones who make all of this work. The faculty are incredibly dedicated people. They've made a commitment beyond just being practitioners within their own field. They've decided to come back and share that knowledge with learners.

I think we've got extraordinary potential, and the thought that we might be wasting any of that really does break my heart.

When you work in an environment like academic medicine, we have so many capable individuals, and you think about what they could do if you could get the right folks at the table at the right time to look at the kinds of problems we're facing. I think the solutions are out there. But we have to talk to each other. We have to build that shared knowledge based. We have to have that ability to catalyze one another's thinking to actually get these problems solved.

There's a saying in the medical school community that when you look at one medical school, you're looking at one school because they're all very unique. I believe that we are all very unique. But I also think that among us we have such common purpose that we really should be thinking about the things where we are catalysts for something together.

It's up to us to think about how to push the frontier about healthcare for people in the United States. So that's not about us just being unique. That's about us using our uniqueness to forge something better and stronger, and I think we've certainly got the capacity to do that.

A role of the leader of the organization can simply be to set a tone that indicates that it's okay to be innovative, it's okay to take risks, and if you are and you have some success, that's going to be recognized. That counts as much as the traditional things in academic medicine.

The models of how we provide healthcare to our patients, how we interact with our patients need to change. Also the models in the way we educate our students need to change. It's been very traditional. Institutions across the decades have changed. Course content has changed the way it's delivered.

But by and large, we're still heavily lecture-based. We should have programs where students can move onto the next subject once they've shown that they're competent in some area, rather than having to finish the semester in that particular class. You know, we're locked into these fixed time scales. Those sorts of models of education need to improve.

Then, also, the learner environment, I think, is also something that suffers from these traditions that we have in medicine. Students pick up a lot of subtle signs about how physicians interact in these environments. Not all of them are good.

There's something called the hidden curriculum, sort of what the students see and hear and experience in addition to what they're actually being taught. Sometimes the messages we're sending in those sorts of learner environments are not the best as well.

The practice of medicine now is very different than what it was when many started their practice of medicine. For some, the feeling is that it's changed for the worse. But if you look at the young students that are coming in who haven't known the previous environment, and the excitement level, and quite honestly, the competency level of the new students coming in is just astounding.

I think that spirit of enthusiasm of a bright future, it's going to be a different future, but it's going to be a bright future. The tools, the power that we have, that hopefully we can harness for the betterment of our patients, is just stronger now than it's ever been in the past.

Socks. Socks. So I went in to have a medical procedure, which everybody needs to have done every five years, and I was told to take off my socks. And I refused, because they really weren't interfering with the procedure they were planning to do. I engaged in a fairly long conversation with the nurse who was adamant that I take my socks off.

So ultimately I didn't take my socks off, but I think that that little parable is indicative of our healthcare system, which is from a clinical perspective totally unable to meet the needs of the customer. It really is focused on the needs of the doctor. So our locations need to be convenient to us, so we can run to our lab and on and on and on.

So one of the first things we're trying to do at Ohio State is to recraft healthcare delivery in a way that actually makes sense, that would be done in any service industry and that focuses on the patient.

There's a great quote by Thomas Edison that I love. "If there's a better way, find it."

I think if you have that approach when you look out in the world, you realize that there's always a better way to do what we're doing now. One of the things that's interesting about being in an academic medical center is that you're not just a healthcare delivery system, you have students, and trainees around, and then of course you have many, many researchers.

It's really in that environment is that you can come up with some of the most creative solutions that we need in healthcare, because you have the brilliance of these researchers, and then you're training students, and trainees who are always questioning "Why do we do things this way? Why can't we do it that way? "

Because we have the resources to answer their questions through our researchers, I think we have the opportunity to create whole new ways of thinking that we never did before.

I'm very motivated when I think there's a vision that seems very clear to me, that requires bringing together people from all different backgrounds, from all different perspectives, and getting them to work together successfully.

The value added comes from different backgrounds, different life experiences, trained in different fields of specialty, creativity. And the great new ideas come at those interfaces.

All of us feel a responsibility to train the next generation of researchers, educators, and healthcare providers. As a result we're not just looking at trying to solve the problems today for tomorrow, but we're looking at trying to solve them for years to come.

My highest hopes for the University of Utah are that we really make a difference to the world, we make people better, and healthier, and happier.

The pieces are already here, the talent is already here, what we really need to be able to do is to allow that talent to flourish, and to provide the overall direction for where we want to go. And then kind of step out, get out of the way, and let everyone move us forward.

To know that individually those people are all doing great things, and they're advancing in their own fields, but by bringing everyone in that room together, and to feel those sparks go off, it's incredibly satisfying.

I do feel a sense of urgency about solving some of these problems. I don't really think it's acceptable to . . . I don't really think it's acceptable that some people don't get the care that they need.

My interaction with the health system is very rich and deep, both as a recipient and someone who offers care to others.

We are in a position where we actually do help people. Sometimes it's one on one. Sometimes it's a very simple thing like holding someone's hand or extending an arm around a shoulder in a really difficult time.

When I started as a nurse, back in the early '70s, children's leukemia, Wilms' tumors, they were almost universally fatal, and now we look to people with these diagnoses to families and young children and we can talk about the hope of being almost always curable, and that is an amazing experience. If we could just deliver that to every single person in this country, just think how strong we would be as a nation.

What we have to confront in our own nation is: Do we have a national commitment to funding research to improve health?

Well, imagine if we have a population that's not healthy, that doesn't have access to the best care that science underpinned. Imagine that absent science we have no idea what works best for whom, in what context, and why.

So how can we confront those challenges? The power of science brings an evidence base to that that really separates it from unguarded or unfounded opinion. So once we have the power of science, we can think about health in terms of improving the health of an individual patient but also of that patient's family, of the community, and the population, many of whom are vulnerable. And I think once we talk about reframing that for innovation as to improving health through all of those, then some of our other challenges may fall away.

I don't know that we've ever, in the course of human history, designed anything that was perfect and could last forever. We need to be ready for change.

As the old joke goes, people will say, "Change is good. You go first." What I see being different now is the people not only acknowledge that change is important and it's good, but more and more of them are willing to go first.

I see groups of institutions forming coalitions that will work on big change, transformational efforts, in their own institution. When that starts to happen, it will ripple throughout academic medicine, and healthcare in general.

The issue isn't competing against each other. The issue is we all have very similar mission statements. We want to improve the health of the public, and that's a big challenge.

Sadly, in many ways, the U.S. healthcare system is broken. We have great medicine. We have great surgeries, great medications and tests. But the system isn't working. And so, more and more what I see the people at this meeting thinking about isn't, "Where do I stand relative to anybody else," but, "Are we innovating? Are we changing ourselves in a way that we really can start to improve the health of the country."

We bring together people from all parts of the medical school, research, teaching, the administration, together with the health system. It's a place where the community really can come together and share ideas. I would argue there's never been a time when we need more new ideas to help us meet the challenges we face.

People who are coming to this meeting are going to leave more ready to push for change, to exert leadership, to argue for innovation on their home campus. All boats will rise together, and eventually we will create a tipping point where I think people will look at academic medical centers in this country ten years from now and say, "We were in trouble when it came to healthcare, and they led the solution.”