Modern Medicine Through The Lens Of The NY Times

Modern Medicine Through The Lens Of The NY Times


Leonard Zwelling

These two stories appeared in The New York Times on January 1, 2018.

The first tells a sorrowful tale of how veterans are getting less than adequate health care at a VA Hospital in Roseburg, Oregon because administrators have taken over the patient care decisions from the doctors. This has arisen in an attempt to bolster the quality scores for the care given at the VA that would in turn translate into bonuses for the administrators and better public relations for the VA. Frightening, right?

But are you sure the same is not occurring where you work?

As patient satisfaction and quality scores (e.g., readmission rates) become more important determinants of payment and serve as surrogates for true quality (outcomes), the role of the hospital administrator in the oversight and operation of patient care has grown. And we physicians have let it happen.

I was thrilled that some of the docs in this story fought for their patients when they needed admissions but were being turned away by administrators who did not want the sickest patients in their empty beds lowering their quality scores. I think these administrators have lost complete touch with what medicine is about. It’s not about the scores. It’s about the patients and this can never be forgotten. The doctors didn’t forget.

The second article is an op-ed penned by Tom Brokaw of NBC news fame. As many may know, and as he points out, as he has aged he has become a frequent consumer of health care. He has multiple myeloma and a host of other afflictions. This is not atypical in our country any longer as we live longer and acquire more infirmities.

Brokaw’s piece links the immigration issue with the health care issue through his experience being cared for in America by people from all over the world and being cared for by them in a more than competent fashion. His point is that President Trump better think very hard as he proposes new immigration laws as well as ways to reform health care as these immigrant caregivers are essential for the functioning of 18% of the American economy and are keys to providing patients with the medical attention they require.

These are big issues in American medicine. What constitutes real quality? How do we compete in America for medical talent from all over the world? How do we reform health care to actually improve the quality, access and affordability of health care, in the only Westernized nation without universally guaranteed health care?

These two articles are worth a read. The first is depressing. The second is enlightening.

We need less of the first and more of the second.

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