Posted by desolationrower on May 29, 2009, at 0:16:45
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
md runs some numbers, then goes to investigate health care in counties that are much higher and much lower in cost and much higher/lower in quality than averager for the US.
the difference is mainly: 'When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing, Cortese told me.' but right now, doctors are paid to do medical things things, instead of paid to make someone healthy, or just paid a salary.
Applying this to psychiatry, there are a few differences (he focused on the expensive common diseases, like cardiac disease). It less of a broad 'money' focus, and more the corruption of the 'opinion leaders' who encourage the side-effect free SSRIs a few years ago, and now are pushing neuroleptics. Unecessary back surgery instead of physical therapy isn't too different from using zyprexa instead of klonopin. Also, not enough thinking or conferring. I think for the average community pdoc, a much better approach would be to work with a half dozen other pdocs. Each specializes in some area, like bipolar, or anxiety, or drug interactions, or whatever. That person reads every study on that area. Then, a new patient comes in and before they start seeing a doctor, the intake has a few questionaires to figure out what is probably their main problem. Most people might not know much about their illness, but most anyone can say 'i feel anxious' or 'i feel like sh*t' or 'i hear voices.' Then they are assigned to the pdoc who specializes in their main problem. After doing the intake, that pdoc could frequently and especially if their are serious comorbidities or non-response to treatment, bring in some other one to discuss how to approach the problem.
-d/r
poster:desolationrower
thread:898211
URL: http://www.dr-bob.org/babble/20090524/msgs/898211.html