The answer to everything wrong in health care

TOP Alberta has released a beautiful infographic Evidence Summary: The Benefits of Continuity in Primary Care, and the document also serves as an overview of the 112 publications they reviewed.

It speaks for itself. Maybe the title of this post is a bit grandiose, but as a shameful hypocrite [I have very little continuity in my clinical practice, something I'm working to remedy] I cannot underscore how important this idea is.

Every physician, nurse, administrator (yes, you!), health policy person, and their uncle needs to not only know this but act on it. Continuity is what we need.

It's not a fad. It's something that we used to have. And it has slowly been eroded, without too many people noticing, as we kept focussing on the newest technology and the latest pharmaceuticals as if they would solve everything.

In BC, the essential nature of continuity has been recognized particularly with the work of Marcus Hollander and was implemented in the GP for Me/Attachment Initiative. Unfortunately (some might dispute this), changing physician incentives to try to encourage more attachment hasn't made much of a difference for patients. So while we know that we need continuity, we don't know how to 'make' the system or the providers do it.

It's a perfect storm for patients: Can't find a GP, or if you can it's hard to build a relationship with them because they are so busy/unavailable/don't have enough time to spend with you; the GP doesn't know all the details of your care as pharmacists/naturopaths and others expand their scope and don't communicate with the GP; the medical records at the hospital or from the specialist in the other city don't link with those of the GP so no one knows what is going on; when a referral or requisition is sent, there is no confirmation that is was received so it might be that you are just waiting, or it might be that it has been lost and you will never hear back about the appointment; when a home care support worker or nurse comes, it is a different person each day and they don't know you or your needs, and they aren't allowed to do the things you need help with most.

Health care really is about caring for people, and how can we do this when we do not build robust and lasting relationships?

The review did not cover provider satisfaction but personally and in BC studies so far, physician satisfaction is improved by continuity with patients. However, this is not how most young graduates are practicing; Yet another great reason that we need to look more into this.

Is it too good to be true? Before we rush ahead and try to force the "magic pill" of continuity, we need to know more about why it's being eroded, and if we can save it, then how?

 

Source: http://www.topalbertadoctors.org/file/top-...

ATTN: Edmonton, Feb 3, 2016 Picard Lecture: Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

Gilbert Welch (img used without permission,  Beacon Broadside )

Gilbert Welch (img used without permission, Beacon Broadside)

I just learned of this event in Edmonton, on Feb 3rd. Don't miss it!

Welch is a persuasive champion of 'less is more' in medicine, and his talks are inspiring, dynamic, and necessary. If you can't attend, check out his latest book, Less Medicine, More Health. RSVP details below. - J.


From The University of Alberta (original post):

"Many doctors are worried about the problems caused by too much medical care. A recent survey suggested that nearly one-half said their patients received too much medical care. But it is hard to communicate the nuances – that medical care can do a lot of good in selected settings, but can also do harm in others – during a 10-15 minute clinic visit.

Doctors like to blame lawyers for the problem of too much medical care. But ask yourself this: Would the problem of overuse disappear if the lawyers disappeared? Economists like to blame economics. But the recipe of adding fee for service to third-party payment to cook up too much medical care would not work without strong underlying beliefs about the value of the product. The general public harbors assumptions about medical care that encourage overuse.

I’m not blaming the public; many of these assumptions flow directly from information provided to them – be it from the news media, talk shows, advertising, PR campaigns, disease advocacy groups, public service announcements or doctors themselves.

Regardless of their source, these assumptions lead individuals to have an excessively optimistic view of medical care. That leads them to seek – some would say to demand, others to accept – too much care.

February 3, 2016
12:00
McLennan Ross Hall (Rm 231/237), Law Centre (111 - 89 Ave)
University of Alberta - Edmonton, AB

Please RSVP here.

Dr. Welch is a general internist and professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Research in the Geisel School of Medicine. He is also a professor of Public Policy at Dartmouth College and a professor of Business Administration at the Amos Tuck School.

For the 25 years he has been practicing medicine, Dr. Welch has been asking hard questions about his profession. His arguments are frequently counter-intuitive, even heretical, yet have regularly appeared in the country's most prestigious medical journals — Annals of Internal Medicine, Journal of the American Medical Association, the New England Journal of Medicine and the Journal of the National Cancer Institute — as well as in op-eds in the Los Angeles Times and the New York Times. His most recent book is Less Medicine, More Health – 7 Assumptions that Drive Too Much Medical Care.

Dr. Welch is very much part of the “Dartmouth School” that questions the assumption that more medical care is always better. His research has focused on the assumption as it relates to diagnosis: that the best strategy to keep people healthy is early diagnosis – and the earlier the better. He has delineated the side-effects of this strategy: physicians test too often, treat too aggressively and tell too many people that they are sick. Much of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, lung, breast and prostate cancer."