6 top medical comments, May 10th, 2009

Here are some of the more interesting comments readers have left recently.

1. Anonymous on whether emergency physicians best served to staff urgent care centers:
As an ED doc, I understand the problem. We are taught to always rule out the emergencies, and I am constantly worrying about the worst case scenario, and likely will order more tests since they are at my disposal, which is not necessarily a bad thing for emergencies but is probably too expensive for less emergency conditions. This mind set, however, might not be the best for urgent care.

2. Throckmorton on health IT is being rushed, potentially leading to patient errors:
In many ways the stimulus to push for IT tech has failed. The problem is that it is government wants to mandate one but nobody has any idea what the government will finally set on. We do not know what the government will require in EMR systems and then we do not know if you have a system if it will talk to the one that the government demands. As a result, there is now a huge disincentive to move towards an EMR or other IT technology. Why buy something now, wait until the Feds figure it out. Of course, the Feds will take forever, so there goes any EMR.

3. Carla Kakutani on whether specialists should be re-trained as primary care physicians:
With the way things are currently set up, what specialists would want to do this? Also, the training would have to be carefully planned out. According to a study in the Journal of Family Practice, having a primary care physician as your personal physician led to 33% lower cost of care and better outcomes compared to using a specialist physician. It would mean teaching the thought process behind managing the undifferentiated patient, handling the interplay of mental health and physical complaints, and learning the myriad health maintenance recommendations, among other things. Without the right training you would have “primary care” without the bang for the buck real primary care provides.

4. Anonymous on doctors being paid on salary:
What a massive shortage of doctors that would create. It would be a race to the bottom to see how little one could work and still receive the salary. What one motivated doctor does now would take 3 salaried doctors to do.

5. Christian Malstrom on whether the best and brightest really should become doctors:
As a medical student, I will say this: we need leadership, not ego; those with a sense of duty, not a desire for status.

The two are often confused (the competitive high-achieving individual, for instance) and in fact I dare say that few people really understand what good leadership really entails. It starts with integrity, ability to inspire, and ability to listen as well as speak.

6. Anonymous on the public health plan option:
For patients, the question should arise: With insurance, you could appeal a decision to not pay a claim, or if worst came to worst, take them to court to seek justice. How does one propose to seek justice from the government, when that government is the same party with whom you have a grievance? Anyone know of any successful suits against a government agency?

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