Recently a Modern Healthcare article http://www.modernhealthcare.com * noted: “Clashing visions of how physicians should practice medicine in the 21st century bubble beneath the surface of nearly every controversial issue in delivery system reform. “
“On the one side is ….a “last-century perspective. It reflects a time when patient outcomes were considered unmeasurable and when the idea of team care meant everyone following the orders of whichever physician was in charge.”
“This approach put heroic practitioners at the center of the diagnosis, treatment and healing process. It posited that the best therapy for any patient should be discerned and delivered by someone with years of training and experience and, hopefully, a personal relationship with the individual in need of care.”
“However, the rapidly evolving protocols of population health medicine and coordinated care challenge that century-old model. They do so both on the medical science and on methods of practice.
“Today, much more is known about what works in medicine, how well it works, and how well it compares to alternative approaches, both in terms of outcomes and costs. This advancing medical knowledge presents practitioners with the choice of making judgments based on their own experiences or following scientifically derived clinical practice guidelines and protocols.”
“No matter what technology gets chosen, physicians and hospitals practicing 21st century medicine will have to confront process issues as they strive to achieve the higher overall quality that leads to better outcomes. There’s no question that adhering to well-defined surgical procedures or immediately administering an aspirin to heart attack patients will reduce unnecessary complications and mortality. The issue is how to achieve 100% compliance with proven standards like those.”
“The old model is stood on its head here, too. To achieve superior performance, the once-unquestionable physician leader must give way to the team. She must adhere to standard protocols for procedures and administer therapeutic approaches that the scientific evidence—which may come just as often from registries and outcomes databases as from clinical trials—suggests will lead to the best outcomes for the greatest number.”
“In this brave new world, variation in care is the enemy of quality—not the wise choice of an experienced clinician. Standardization is the surest path to achieving the best outcomes. It is analogous to the wise investor picking an index fund over the stock-picking money manager who once had a good year.”
*to read the full MHC article “Clashing visions on medical care practice prove to be hurdle” by Merrll Goozner, highlight and click on open hyperlink http://www.modernhealthcare.com/article/20140517/MAGAZINE/305179983&utm_source=AltURL&utm_medium=email&utm_campaign=am?AllowView=VXQ0UnpwZTVEL1daL1I3TkErT1lBajNja0U4VUQrZGFFQk1JQnc9PQ==&utm_campaign=am&mh
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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
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