Here are some of the more interesting comments readers have left recently.
1. David Block on the ACP’s guest column, A practice model for increasing the appeal of General Internal Medicine:
Weinberger talks about the efficiency of Care. Our commentators talk about the efficiency of Consumption. Weinberger assumes the one-on-one of two individuals, known to each other, who together negotiate the terms of personhood. Medicine is “spiritus”; no wonder he became a physician of breath. Our hospitalists, no less deeply moved, point out that we exist in a managerial hierarchy, that we provide a fungible commodity in the eyes of that hierarchy, and that we will respond on the basis of how we are rewarded.
2. Donald Green on whether rationing health care impossible in the United States:
Care is already rationed in this country by ability to pay. No matter what reform comes, however, the cost of care will always be an issue as it is even in countries that pay far less for care. This is not the problem. The problem is how we pay for this to get the most bang for the buck. As we add more services and professionals to the health care system, its price will go up. The decision making will continue to be a political football. If there are reduced barriers between patient and doctor perhaps treatment will not have to reach the confrontational stage. I notice that the private insurers are not mentioned in the above entry and frankly they are worse in ensuring services for people.
3. PookieMD on how to get doctors to embrace health care reform:
I think physicians are slow to support reform for two reasons: 1) limited time–if you are struggling to make your practice viable, you probably don’t have a lot of time to go out and lobby; and, 2) the belief that nothing will change, and that efforts will bear no fruit. Our time is so precious, it is hard to spend it on something we view as futile.
4. CIO on how a referral to a specialist turns patients into currency:
Another significant issue is that patients are being increasingly referred by PCPs for issues which do not seem to require specialty care. Sub-specialty input in such cases is often superfluous or unnecessary and it is definitely more expensive to the patient and insurer. In the past, PCPs would have handled such cases by themselves however, they now refer such cases to a specialist.
The result is patient frustration, more expense and less value. Specialists fees notwithstanding, everyone loses.
5. Susan Carr on physician apologies:
I feel it’s important to point out that an apology is not necessarily the same thing as “expressing sympathy” or even “saying sorry.” A proper apology is a sincere statement of responsibility. To say “I apologize for my actions, and I’m sorry for the harm I caused” is very different from “I’m sorry that you were injured,” or even more remotely, “I’m sorry you feel the way you do” (which may imply lack of agreement). The distinctions are important in the context of adverse medical events, where details of actions and responsibility may be complicated and take some time to understand. The effect of empathy, clear communication, and compassion are crucial for all involved.
