RE: Re: Is inappropriate primary care the problem with US health care?

[Guest guest]

OK, sorry for this, but for the third time this morning, I'll say,

" ditto. " Chad, your post and the questions raised by it

were excellent, even helpful in the on-going conversation that we are all part

of. No one post will be the answer to all of health care's problems (though

those of Gordon, Brady, and many others often seem close to doing that!!

;-). But each post helps us keep moving in the right direction I believe.I think I was one of the folks who answered " passionately " and

disagreed with the feelings of your friend. But, as someone who joined the

list when there were only a couple dozen of us, I'll say that the passions we feel

for issues on this list do not, or at least rarely, reflect on the person we are

responding too. (I'd still love to know what he thinks to some of the

questions we raised. His thoughts could be valuable to us all. Please share them if

you ever have the chance)Let's remember, life has no destination. The

journey is the destination. I very much believe that we are all better doctors

simply because of the conversation we are all part of here, as well as our wish to

be better than we have been in the past or think we would be in a different

situation. For me, that is the essence and the beauty of this list serve!All the best --TimOn Fri, December 19, 2008 9:22 am EST, L. Gordon wrote:

I thought your post was great and veryhelpful in stimulating discussion, even when folks respond with passion,

don’tfeel beleaguered & keep on posting.

Thank you for your contributions. I

agreethat we need to avoid the easy solutions, avoid simple blaming &

bashingand continue to be inventive and thoughtful.

Gordon

From:

[mailto: ]

On Behalf Of chadcostleySent: Friday, December

19, 20084:22 AMTo: Subject: Re:

Is inappropriate primary care the problem with US health care?

Completely agree. My posts the last couple of dayswere only intendedto spark a conversation about things we can do immediately

to improveour own performance while we advocate for proper support from thesystem. I labeled the first post as " food for thought " - hope no onethought my intent was to blame primary care for the mess. However, Ido

believe that we will be most effective as a solution if we can showthat we

practice in ways supported by evidence rather than habit orpatient demand. I

know it's a chicken and egg problem - we don't havea system that supports

doing the right things so we often don't do theright things. However, to be

effective, I need to avoid the easyroute of simply blaming insurance

companies, specialists, thegovernment and the stars for all that is wrong - we

are not completelypowerless as primary care docs. That was my only intent in

spurringwhat I hope at least some found to be a friendly debate worth

having.Best and happy holidays.Chad>> No need to speculate

on this topic, there are volumes of publications on> this issue. I present

one of the most recent - not as the> be-all-and-end-all of

publications, but merely as a reflection of awealth> of data.> > > > Parts of the USwith greater

concentrations of PCP per capita havebetter> satisfaction, better

health outcomes, lower total cost.> > Parts of the USwith

greater concentrations of specialty care andhospital> beds have worse

satisfaction, worse outcomes and higher total cost.> > >

> The reasons are explained in the attached..> > > > Does this mean primary care is pristine and we only need more of

usaround?> Not for a second. There are certainly times when PCPs

orderinappropriate> tests and treatments, there good studies

documenting the inadequatelevels> of care delivered by PCPs in the

US. This is an unfortunateconsequence of> being put in the

professional equivalent of Lucille Ball on the assembly> line in the candy

factory.> > > > The current system is perfectly

designed to get us these woeful results:> inadequate resources, low

fee-for-service pay for visits and noremuneration> for all the other

work of primary care, the unfunded mandate of theinsane>

administrative trivia game (billing, prior auth, and forms from hereto our> collective grave). In general we are on a diabolical treadmill andunable> to live up to our professional obligations.> >

> > We can work to put our houses in order, to use the best

medicalinformation> to support our patients, to provide superb

access, excellentcontinuity, a> broad array of service, and

coordinate care across the continuumwhen we are> adequately resourced

to do the work and we lose the crushing yoke of> administrative trivial

pursuit.> > > > High performing health systems

are founded on effective primarycare. Give> us the resources and

relief we need to do our work.> > G>

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

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[Guest guest]

OK, sorry for this, but for the third time this morning, I'll say,

" ditto. " Chad, your post and the questions raised by it

were excellent, even helpful in the on-going conversation that we are all part

of. No one post will be the answer to all of health care's problems (though

those of Gordon, Brady, and many others often seem close to doing that!!

;-). But each post helps us keep moving in the right direction I believe.I think I was one of the folks who answered " passionately " and

disagreed with the feelings of your friend. But, as someone who joined the

list when there were only a couple dozen of us, I'll say that the passions we feel

for issues on this list do not, or at least rarely, reflect on the person we are

responding too. (I'd still love to know what he thinks to some of the

questions we raised. His thoughts could be valuable to us all. Please share them if

you ever have the chance)Let's remember, life has no destination. The

journey is the destination. I very much believe that we are all better doctors

simply because of the conversation we are all part of here, as well as our wish to

be better than we have been in the past or think we would be in a different

situation. For me, that is the essence and the beauty of this list serve!All the best --TimOn Fri, December 19, 2008 9:22 am EST, L. Gordon wrote:

I thought your post was great and veryhelpful in stimulating discussion, even when folks respond with passion,

don’tfeel beleaguered & keep on posting.

Thank you for your contributions. I

agreethat we need to avoid the easy solutions, avoid simple blaming &

bashingand continue to be inventive and thoughtful.

Gordon

From:

[mailto: ]

On Behalf Of chadcostleySent: Friday, December

19, 20084:22 AMTo: Subject: Re:

Is inappropriate primary care the problem with US health care?

Completely agree. My posts the last couple of dayswere only intendedto spark a conversation about things we can do immediately

to improveour own performance while we advocate for proper support from thesystem. I labeled the first post as " food for thought " - hope no onethought my intent was to blame primary care for the mess. However, Ido

believe that we will be most effective as a solution if we can showthat we

practice in ways supported by evidence rather than habit orpatient demand. I

know it's a chicken and egg problem - we don't havea system that supports

doing the right things so we often don't do theright things. However, to be

effective, I need to avoid the easyroute of simply blaming insurance

companies, specialists, thegovernment and the stars for all that is wrong - we

are not completelypowerless as primary care docs. That was my only intent in

spurringwhat I hope at least some found to be a friendly debate worth

having.Best and happy holidays.Chad>> No need to speculate

on this topic, there are volumes of publications on> this issue. I present

one of the most recent - not as the> be-all-and-end-all of

publications, but merely as a reflection of awealth> of data.> > > > Parts of the USwith greater

concentrations of PCP per capita havebetter> satisfaction, better

health outcomes, lower total cost.> > Parts of the USwith

greater concentrations of specialty care andhospital> beds have worse

satisfaction, worse outcomes and higher total cost.> > >

> The reasons are explained in the attached..> > > > Does this mean primary care is pristine and we only need more of

usaround?> Not for a second. There are certainly times when PCPs

orderinappropriate> tests and treatments, there good studies

documenting the inadequatelevels> of care delivered by PCPs in the

US. This is an unfortunateconsequence of> being put in the

professional equivalent of Lucille Ball on the assembly> line in the candy

factory.> > > > The current system is perfectly

designed to get us these woeful results:> inadequate resources, low

fee-for-service pay for visits and noremuneration> for all the other

work of primary care, the unfunded mandate of theinsane>

administrative trivia game (billing, prior auth, and forms from hereto our> collective grave). In general we are on a diabolical treadmill andunable> to live up to our professional obligations.> >

> > We can work to put our houses in order, to use the best

medicalinformation> to support our patients, to provide superb

access, excellentcontinuity, a> broad array of service, and

coordinate care across the continuumwhen we are> adequately resourced

to do the work and we lose the crushing yoke of> administrative trivial

pursuit.> > > > High performing health systems

are founded on effective primarycare. Give> us the resources and

relief we need to do our work.> > G>

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------