July 13th, 2011 by Davis Liu, M.D. in Book Reviews, Opinion
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I have had the privilege of working at an organization which is actively improving the lives of its members and also was mentioned by the President as a model for the nation. Over the past few years, I have also demonstrated to first year medical students what 21st century primary care should look and feel like – a fully comprehensive medical record, secure email to patients, support from specialists, and assistance from chronic conditions staff.
But as my students know, there are also some suggested reading assignments. I’m not talking about Harrison’s or other more traditional textbooks related to medical education. If the United States is to have a viable and functioning health care system, then it will need every single physician to be engaged and involved. I’m not just helping train the next group of doctors (and hopefully primary care doctors), but the next generation of physician leaders.
Here are the books listed in order of recommended reading, from easiest to most difficult. Combined these books offer an understanding the complexity of the problem, the importance of language in diagnosing a patient, the mindset that we can do better, and the solution to fixing the health care system.
Which additional books or articles do you think current and future doctors should know?
Overtreated – Why Too Much Medicine Is Making Us Sicker and Poorer Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
June 20th, 2011 by Davis Liu, M.D. in Opinion
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Doctors are professionals. But are doctors cowboys or pit crews? Recently, physician writer, Dr. Atul Gawande, spoke about the challenges for the next generation of doctors in his commencement speech titled, Cowboys and Pit Crews, at Harvard Medical School. Gawande notes that advancement of knowledge in American medicine has resulted in an amazing ability to provide care that was impossible a century ago. Yet, something else also occurred in the process.
“[Medicine’s complexity] has exceeded our individual capabilities as doctors…
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”
Despite all of the advancements in medicine, the outcomes and consistency in treatment and care are not as good as they could be. Doctors are not doing basic things. The fact that Gawande, author of The Checklist Manifesto, spoke at one of the finest medical schools in the country indicates how much more the profession needs to go.
“We don’t have to look far for evidence. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
June 13th, 2011 by Davis Liu, M.D. in True Stories
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Dr. Mehmet Oz recently had a piece in Time titled “What I Learned from My Cancer Scare” in which he became the the more humbled Mr. Mehmet Oz. As noted previously here, Dr. Oz last summer had a colonoscopy at age 50 and much to everyone’s surprise had a precancerous colon polyp. He was advised to follow-up again for a repeat test in 3 months.
As the Time magazine piece noted, he didn’t return for 9 months despite repeated reminders from his doctor.
From this experience, he essentially stumbled upon what has been challenging American medicine and primary care. How do we enable patients to do the right thing and get the screening tests done and treatments necessary to avoid premature death and maintain a high quality of life? As a highly trained professional, Dr. Oz knows the risks and benefits of not doing a preventive screening test. As a doctor, he knows all of the secret protocols and codespeak we use when calling patients or asking them to see us in the office for important matters. As a doctor, he also understood the importance of a repeat colonoscopy to ensure no more colon growths.
Yet he didn’t return for 9 months. Why? Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
May 4th, 2011 by Davis Liu, M.D. in Primary Care Wednesdays
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The New York Times recently published an article titled the Family Can’t Give Away Solo Practice wistfully noting that doctors like Dr. Ronald Sroka and “doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat…larger practices tend to be less intimate”
As a practicing family doctor of Gen X, I applaud Dr. Sroka for his many years of dedication and service. How he can keep 4000 patients completely clear and straight in a paper-based medical system is frankly amazing. Of course, there was a price. His life was focused solely around medicine which was the norm of his generation. Just because the current cohort of doctors wish to define themselves as more than their medical degree does not mean the care they provide is necessarily less personal or intimate or that the larger practices they join need to be as well. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
April 21st, 2011 by Davis Liu, M.D. in Health Policy, Opinion
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The future direction of American health care is unclear. Certainly the cost trend as it exists is unsustainable with health care costs being a major concern of the private sector, the government, and individuals. How does the nation manage costs while ensuring high quality medical care, access, and service? Proposals include increasing competition among insurers, providers, and hospitals to drive down prices or giving more financial responsibility to patients via higher deductibles and co-pays with the belief that they will demand price transparency, shop around for the best price, and as a result slow health care costs.
What if both ideas are wrong?
While it is possible these plans might work, I cannot help but notice the similarities in the challenges for patients in navigating the health care system and consumers figuring out how to purchase and use technology. Walk into your neighborhood electronics store. Individuals are overwhelmed with the number of product choices, manufacturers, differences in technical specifications and features. In the majority of situations, consumers are unsure of what they are purchasing. They want something that just works, whether surfing the internet, making home movies, or being connected with loved ones. The gap in knowledge between an expert and a consumer is great and often unintentional and unapparent. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
I have had the privilege of working at an organization which is actively improving the lives of its members and also was mentioned by the President as a model for the nation. Over the past few years, I have also demonstrated to first year medical students what 21st century primary care should look and feel like – a fully comprehensive medical record, secure email to patients, support from specialists, and assistance from chronic conditions staff.
