June 3, 2012

THE KEY TO REFORMING MEDICINE IS JUST CONSUMING LESS OF IT:

Squeezing out the doctor : The role of physicians at the centre of health care is under pressure (The Economist, Jun 2nd 2012)

Less flashy technology, though, could make the biggest difference by reducing the number of crises which require a doctor's intervention. Marta Pettit works on a programme to manage chronic conditions that is run from Montefiore Medical Centre, the largest hospital system in the Bronx, a New York borough. Ms Pettit and a squadron of other "care co-ordinators" examine a stream of data gathered from health records and devices in patients' homes, such as the Health Buddy. Made by Bosch, a German engineering company, the Health Buddy asks patients questions about their symptoms each day. If a diabetic's blood sugar jumps, or a patient with congestive heart failure shows a sudden weight gain, Ms Pettit calls the patient and, if necessary, alerts her superior, a nurse.

Other tasks are simpler, but no less important. Montefiore noticed that one old woman was not seeing her doctor because she was scared of crossing the Grand Concourse, a busy road in the Bronx. So Montefiore found a new doctor on her side of the Concourse. Together, such measures make a difference. Diabetics' trips to hospital plunged by 30% between 2006 and 2010; their costs dropped by 12%. [...]

America has led the world in developing the roles of nurse practitioners and physician assistants. Other, less trained workers are proliferating there too. The number of "diagnostic medical sonographers", who have two years of training, is expected to jump by 44% between 2010 and 2020, according to the Bureau of Labour Statistics. Yet productivity still falls. This seems to be because new ways of doing things, and of managing health teams, have not kept pace--and are still under the control of doctors.

The doctors' power rests on their professional prestige rather than managerial acumen, for which they are neither selected nor trained. But it is a power that they wish to keep. The Confederation of Medical Associations in Asia and Oceania, a regional group of doctors' lobbies, wants "task-shifting" limited to emergencies. Japan's medical lobby has vehemently opposed the creation of nurse practitioners. India's proposal for a rural cadre outraged the country's medical establishment, and legislation to create the three-and-a-half-year degree has gone nowhere.

In 2010 America's respected Institute of Medicine (IOM) called for nurses to play a greater role in primary care. Among other barriers, nurses face wildly different constraints from one state to another. But any change will first require swaying the doctors. The American Medical Association, the main doctors' lobby, greeted the IOM's report with a veiled snarl. "Nurses are critical to the health-care team, but there is no substitute for education and training," the group said in a statement.

Posted by at June 3, 2012 7:49 AM
  

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