Two Articles Address Quality of U.S. Healthcare

Two recent articles in prominent publications identify the general internist as a key factor in solving the current healthcare crisis in the U.S. An article in the New England Journal of Medicine and one in the Washington Post examine quality and value of medical services from different points of view as each reports on innovations.  The article in NEJM’s November 27 issue by Susan Okie, MD, is titled “Innovation in Primary Care—Staying One Step Ahead of Burnout.” The article in the November 30^th edition of the Washington Post is written by Ceci Connolly and titled “U.S. ‘Not Getting What We Pay For’: Many Experts Say Health-Care System Inefficient, Wasteful.”

Okie’s NEJM article focuses on experiments in physician-initiated innovations in office practices that allow primary care doctors to “work smarter, not harder” and thus find more satisfaction in their day-to-day work. Strategies cited include devolving as much routine work as possible to nurses and clerical staff instead of cutting support staff as is often done to cut costs, and taking a rational look at the sequencing of care activities.  For patients requiring frequent monitoring, “alternative encounters” such as appointments in groups, by telephone or by e-mail have been initiated. These attempts aim to make life as a general internist more workable and satisfying for practitioners, and thus help to stanch the growing shortage of primary care physicians.

Donnelly’s article in the Washington Post describes challenges for the incoming Obama administration in containing health costs. The article quotes Gary Kaplan, Chairman of the Virginia Mason Medical Center in Seattle as claiming that “as much as half of the $2.3 trillion spent today does nothing to improve health.”  Factors that many experts agree can contribute to improving the cost-benefit ratio in healthcare are research on effectiveness of treatments and a shift of emphasis to prevention and wellness. Central to this mission is to “build primary care as the core.”

For the full text of each of these articles, consult the publication’s website:

New England Journal of Medicine

Washington Post