Ours is a provider-oriented system. Doctors like me and (former) hospital executives like me hate to admit it but it is true. Consumerism will slowly but surely drive it toward being a patient-oriented service model. What do patients and their families want from the health care delivery team? First and foremost is respect followed by service given in a high quality, very safe manner. Patients expect that the information gap ...

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A guest column by the American College of Physicians, exclusive to KevinMD.com. In preparation for a panel discussion at Internal Medicine 2012, the annual scientific meeting of the American College of Physicians, I was asked some questions about changes I would make in health care if I were king. That stimulated some serious thinking. For those of us in practice it is more usual to think about what new ...

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I recently watched Dr. Atul Gawande on video describe how what American healthcare needs is pit crews and not cowboys.  This sentiment is also memorialized in his thought-provoking writings for the New Yorker. Interestingly, Dr. Gawande is not the first person I have heard to suggest such a thing.  A colleague named Dr. Ken Catchpole actually studied Formula 1 pit crews and used the information to guide improvements ...

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The biggest problem with health care delivery in the US is cost, which seems to have taken a back seat to other issues meant to be addressed by health care reform. We spend about $2.5 trillion dollars a year on health care—that’s over eight thousand dollars a year for every man, woman, and child. What’s that getting you? According to the government, about 30% goes to hospitals; 20% ...

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In the current climate of health care reform, it is important to understand doctors and the work they do. I have found 3 common misconceptions, held even by doctors themselves, concerning the job of being a doctor. The first is the idea that doctors are conservative, resistant to change. Facts show that doctors deal with change all the time. They are familiar with the concept of change for change's sake and ...

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Three out of four dentists recommend this tooth brightening toothpaste -- make your smile sparkle like never before! Six out of seven plumbers recommend this drain opening de-clogger -- make your bathtub drain like never before! Nine out of ten doctors recommend improving the medical system in the United States -- make your health care system heal like never before! But how do we do that? Do doctors think the Affordable Care Act is the soothing balm ...

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An excerpt from Potent Medicine The Collaborative Cure for Healthcare. It was mid-summer 2010 when the full scope of everything that Nancy D’Agostino did not know hit home. Still raw from surgery and missing parts of her body, she thought that all the hard choices were behind   her.  Then  here   was  a  new  face,  a  radiation  oncologist, outlining  side  effects of treatment  and  asking her to  choose. And then a medical ...

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There will be some very disruptive and some transformational changes in the way health care is delivered, not as a result of reform, but as a result of the drivers of change described in a previous post on KevinMD.com. They included an aging population, an obese society, shortages of doctors, and emerging consumerism, among others. I interviewed in depth about 150 medical leaders from across the United States to collect ...

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Patients have been arriving at the doors of emergency departments in increasing numbers over the past decade, and this trend will only grow in the future. I believe there are five key factors that suggest every ED should brace itself for a never-ending rush hour. As the CEO of a physician group that provides medical care to over 4 million patients per year, I have the opportunity to study in great ...

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Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future.  I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions.  That is, reimbursement will be based upon the quality of service delivered by the provider.  For insurers, whether private or governmental, I believe that ...

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