A Medical Student View

As a first year medical student at the University of Wisconsin School of Medicine and Public health, I have been exposed to inpatient care right from the start; which highlights its importance in my future profession. One model of healthcare delivery that seems to relate to reform proposal 2’s argument for greater access to care to prevent medical emergencies as well as well as reform proposal 1’s focus on coverage for pre-existing conditions is the “medical home” model. It stresses a long-term relationship with a primary care provider, extensive integration among the different members of a patient’s care team, and a focus of the “whole” person as opposed to their relevant symptoms. An important aspect of this model is electronic records to facilitate integration and improve quality and safety. Electronic medical records, and other health promoting and potentially cost effective stratigies (for example community health promotion/education programs and increased access to primary care providers, ) come with a price. While these improvements that would eventually save money in the long run they are a large financial commitment initially, and especially difficult to garner support for in a tough economic climate.

An important aspect of impatient care is quality control. In the past, healthcare has been different from other service providing entities in that there was less focus on cost effectiveness, quality of care, and efficiency. This was a time when there were fewer options for places to go to receive care, and patients’ role in their care was one of taking orders. Things have changed, and with more options for care, a more business-minded approach to healthcare, and patients’ taking a more active role in their health, efficiency and cost effectiveness have become just as important as in any other business. While I see the positives of reducing wasteful and unneeded tests and procedures, it has been an adjustment integrate a business view of medicine that I didn’t really consider when I decided to enter the field of medicine.

Another strategy for efficiency and cost-effectiveness is “pay-for performance” measures for physicians. A discussion of this public health class brought up questions of how exactly to measure performance and outcomes, and how this assessment would differ for physicians with vastly different patient populations. In any healthcare delivery environment, following evidence-based, facility supported practices is important, and this is especially true in inpatient care. Many situations have predictable and proven decisions that follow, and if the evidence is behind it, it makes sense to follow it. I also think physicians should be held accountable for their decisions and take cost considerations into account when making decisions. I do worry about that making medicine more of as algorithm following science than an interpersonal art takes the personal touch out of medicine. I also wonder if the measures could have the potential of focusing on efficiency and cost effectiveness to the point that quality of care could decrease and decreasing needing procedures/tests could have the potential to be rewarded.

I can appreciate both sides to the universal healthcare debate. What I feel strongly about is that there are for too many people without access to care and that any legislation passed to improve the health of this nation will look at the “upstream” reasons that bring people to the hospital in the first place.