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Hello Dr. Feld,

I like your point about how fixing the healthcare system cannot be about pure profit, but has to be about the patient. None of the major healthcare players really think about the patient except the physicians. And even they are constantly being forced to think about the patient in an acute setting. The diabetic patient who comes in with a necrotic foot is not a Diabetic first, but rather a person with a necrotic foot problem. Once the foot is treated or amputated it's back home for the patient, with no further concern for his ongoing diabetes. It just doesn't make sense. Out system is optimized for acute care, but even that is incredibly expensive, and has mixed levels of delivery.

I have been thinking a bit about your statement that no one has asked physicians how to fix the healthcare system, and I wonder if the issue is really not that physicians haven't been asked, but rather that physicians have not taken a proactive stance towards fixing the healthcare systems. In my experience working in hospitals I have seen several complex policies thrown at hospitals and physicians from the government and from insurance providers. Sometimes the policies were created by physicians who now work for these organizations. Usually practicing physicians will just adapt. It's easier to just deal with the policy and go on seeing patients that really need to be seen than to take time out of a busy practice to go upstream and try and fix the problem at its roots.

We can't just sit back and expect that the policymakers will beat a path to our doors to ask our opinion on what should be done. We need to take the steps to put ourselves in positions of influence. Only then will we be able to change the system. The alternate approach is to try to build something that is more attractive, but that also requires significant influence, beyond just knowing pure medicine.

I think your blog is an excellent step towards getting people a good framework to think about these issues so when we do get some physicians into those positions they will have their heads screwed on straight.

Hope these ramblings weren't too rambling.

Thanks again. I eagerly look forward to your next post.

Hello Anoymous

You hit on several important points. It is indeed too difficult to go out and try to change the system when you have to and love to see patients and try to help them.

Your patients and your multiplier. You have to educate and motivate them to go out and change the system. I will get into the instruction on how to do this in detail as the blog progresses. Meanwhile we need a posse' to gather up the patients to do this for them and us.

You can help by having all your friends subscribe to the blog.

Thanks for your comment

Stanley Feld M.D.,M.A.C.E.

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