| End of Primary Care?
In 1996, a third of the medical students in the United States planned to
practice primary care medicine, and a report from the Institute of Medicine
showed that people treated by primary care physicians spent less time in the
hospital, had fewer visits to the emergency room, had fewer procedures and tests
— and were healthier.
Yet by 2003, primary care was in serious decline. Not only doctors but
patients as well increasingly avoid it, writes Lisa Sanders in the New York
Times, preferring to visit emergency rooms and specialists directly. What
went wrong?
Mainly, she says, it was HMO use of primary care physicians as gatekeepers,
deciding on whether or not a patient should receive a test or procedure or a
referral to a specialist, and — in theory but not, it turned out, in
sustainable practice — cutting costs. Worse, it created a conflict of interest
between doctor and patient and broke the bond of trust. Patients increasingly
make their own decisions to go see a specialist or visit an ER, without
consulting a primary care doctor.
To maintain revenue, primary care doctors have resorted to squeezing in more
patients, making it more difficult to develop the relationships that were a
chief reward for the physician. Technology may rescue them as they struggle to
be efficient enough to spend the time they need with their patients, but for
now, real primary care seems to be becoming a luxury affordable only to those
who can afford VIP medicine.
Reference: Sanders, Lisa (2004). “The End of
Primary Care.” New York Times, April 18.
Office of Tomorrow
Among technologies that could be improving office productivity in as few as
five years are wraparound screens more than three times the width of today’s
typical 17 inch computer monitor, projectors that turn walls and floors and
conference table tops into giant screens, a desk chair that senses when its
occupant is stressed, and invisible computers with enough intelligence to
understand everything in your computer files and serve as your personal
assistant.
Office furniture maker Steelcase, Microsoft, IBM, Sandia National
Laboratories are among the many major organizations preparing to meet the need.
The Palo Alto Research Center (PARC) is developing a program that can summarize
a (say) 400-page report and present its key points in grammatically correct
sentences in just a few pages.
It’s not just that the technology to do all this is now possible and
affordable, but that it is necessary “to compensate for the growing complexity
of many jobs” writes Olga Kharif in Business Week. It is hard to imagine
many jobs becoming more complex than those in medicine.
Reference: Kharif, Olga (2004). “Sneak
Peeks at Tomorrow’s Office: From wraparound computer screens to ‘electronic
assistants’ that summarize data, here’s what you have to look forward to.”
Business Week, April 13.
Radiology Outsourcing
A growing shortage of radiologists in the US, increased use of imaging
studies in emergency departments, the growth of Internet bandwidth, and the
growing availability of less expensive radiologists overseas have spurred the
trend to offshore outsourcing of radiology. More than 350 US hospitals,
radiology groups, and clinics now use a service based in Australia. The American
College of Radiology is responding by calling for physicians who interpret
teleradiology images to:
- Be licensed to practice medicine in the state where the imaging exam
originates;
- Be credentialed as a provider and maintain appropriate privileges in the
facility or hospital where the exam originates;
- Have medical liability coverage in the state where the exam originates; and
- Be responsible for the quality of the images interpreted.
These are not the barriers one might think. The Australian operation meets
these requirements, as do a growing number of similar operations in India, the
United Kingdom, Israel, and South Korea. They don’t completely eliminate the
need for local radiologists because (for one thing) Medicare won’t reimburse for
offshore final reads, so the offshore operations focus on preliminary reads of
patient scans.
Teleradiology costs range from $50 to $70 per study. For a small hospital
with about 100 cases to interpret per month, it could cost $60,000 to $84,000
per year, according to a paper in the April issue of the Journal of the American
College of Radiology.
Reference: Broder, Caroline (2004). “Teleradiology
Services Help Meet Demand, Shortages.” iHealthBeat, April 8.
Videogames and Surgeons
In a recent study, doctors who spent at least three hours a week playing
video games made about 37 percent fewer mistakes in laparoscopic surgery and
performed the task 27 percent faster than their counterparts who did not play
video games, reports the Associated Press. At least one US medical school is
incorporating video games into surgery training.
Reference: Unknown (2004). “Surgeons
Who Play Video Games Err Less.” Associated Press via New York Times, April
7
.Exotic Diseases
The rapid global spread of exotic diseases such as monkeypox and SARS has
many care providers weighing their duty to patients versus their duty to family,
neighbors, and colleagues, who could also become infected by the caregiver.
It happens in African hospitals, where an outbreak of Ebola often sends most
of the medical staff heading for the hills. And it happens here. When SARS hit
in Toronto last year ”It was hard at first to find doctors to cover the SARS
wards,” said one Canadian doctor. The fear is justified: “Some of those who
developed SARS in Toronto, as in Hanoi and elsewhere, were the children,
parents, siblings or close friends of hospital workers. Not all of them
survived.”
Reference: Reynolds, Gretchen (2004). “Why Were
Doctors Afraid to Treat Rebecca McLester?” New York Times, April 18.
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