Guest guest Posted November 25, 2007 Report Share Posted November 25, 2007 Fight ignorance with measurement. Also, telling is that the "leader" of the large multispecialty group isn't even a doc, but a PhD. Large integrated practices have felt for a long time that they're the "way to go." The victory here we must build on is the "little crack in the armor" that Gordon's been able to show that IMP care is BETTER than the "big guys" who charge more. Money talks, though, and the biggest failure is that IMP in many places do NOT bring in as much as group practices. I' m working on this, as are you all, although I suspect that my method of cutting overhead may not be the same as yours, but we'll see.... And the AAFP actually STILL has a majority of docs in 5 or less in a group, if I'm not mistaken. Comments? Matt from Western PA amw news article very interesting.to my reading, there are several sets of statistics referred to in the article, each supporting different points, and none of which use the same statistical base.there are, i believe, four studies quoted supporting the idea that bigger is better, and one which supports smaller is better.there is no mention of where the surveyed doctor's practices are, urban, rural, suburban, what the patient's payer sources are, and what the patient's co-morbid conditions may be, along with socio-economic status, all of which may effect care and outcomes.the large, corporate model infers within-the-group referrals for specialty care and patient education, whereas a solo doctor may incorporate patient education into the encounter, and depend on a referral network for specialty care, over which the doctor has no control.it's also clearly stated that solo doctors must not be well-educated and practice a poor quality of medicine, if for no other reason than that they practice alone. although the practice of medicine has and continues to change, there are some fundamentals of health care and doctoring which haven't, and that's prevention. is it better to help prevent the heart attack or stroke, or to know the latest medication, shortly to be recalled by FDA?the article also infers that use of an emr is very expensive, and that only large, corporate practices can afford them.i think the only way to reasonably determine how good any given patient's health care may be is to apply the same standard across the board.obviously one tool is the "how's your health" questionnaire, but there is another point the article makes which must be addressed-- are we smaller practices in fact prescribing the appropriate treatments for post-MI, post-stroke and diabetes, to name a few.certainly there must be a relatively simple search one can do with one's poor little emr, backward and inexpensive as it may be.i suspect the large corporate medical groups are scared of small groups and solo practitioners, and by quoting scattered statistics here and there, can sow fear and loathing of us.but then again, i wonder, if the large corporate insurance companies were only to contract with large corporate medical practices, using statistics such as this as their rationale, where will we be left?and if socialized medicine actually happens here in the US, do you think the government will want to contract with solo docs and small practices providing allegedly sub-standard care, or some large corporate entity who "can do it all", supposedly with the outcomes to back it up?what do you think?LL Never miss a thing. Make Yahoo your homepage. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2007 Report Share Posted November 29, 2007 You bring up a lot of good and valid points. The most important being: does P4P that looks at frequency of visits, med usage, lab testing as indirect markers of good medical management lead to improved outcomes for the patients? On the other hand, you could ask the same thing about data from HYH. Good outcomes are a moving target in primary care (as opposed to markers such as post-op complications in the surgery field, even then the surgeons with the most complications argue they care for the most complicated patients that other surgeons won’t touch). I believe you let the consumer decide, they will vote with their feet. Personally, I think good doctors provide good care no matter what type of practice they’re in and vice versa for bad doctors. As an aside, there may be one good point of a socialized health system that isn’t being considered. I thank Terry Gross’ Fresh Air for this. Monday’s show had Mark Shapiro commenting on the EU’s banning of Phtlates in children’s toys, toxic material’s in cosmetics, and toxic metals and chemicals in electronics that end of in landfills and the US govt’s lack of action on these same issues. Terry wondered if corporate lobbyists were the main reason for the lack of action. Mr. Shapiro pointed out that while lobbyist obvioulsly have a role, the EU has a fair number of lobbyists as well. He believed one main reason was the socialized medicine situation in the EU. Since the governments are going to pay the costs for the results of these toxic exposures down the road, they are much more likely to take action early as a cost savings measure. In the US, where individuals pay the cost and to some degree the insurance companies, the govt has less financial incentive to maintain a healthy population and therefore, damage has to be proven before substances are banned. Straz Charlottesville, VA amw news article very interesting. to my reading, there are several sets of statistics referred to in the article, each supporting different points, and none of which use the same statistical base. there are, i believe, four studies quoted supporting the idea that bigger is better, and one which supports smaller is better. there is no mention of where the surveyed doctor's practices are, urban, rural, suburban, what the patient's payer sources are, and what the patient's co-morbid conditions may be, along with socio-economic status, all of which may effect care and outcomes. the large, corporate model infers within-the-group referrals for specialty care and patient education, whereas a solo doctor may incorporate patient education into the encounter, and depend on a referral network for specialty care, over which the doctor has no control. it's also clearly stated that solo doctors must not be well-educated and practice a poor quality of medicine, if for no other reason than that they practice alone. although the practice of medicine has and continues to change, there are some fundamentals of health care and doctoring which haven't, and that's prevention. is it better to help prevent the heart attack or stroke, or to know the latest medication, shortly to be recalled by FDA? the article also infers that use of an emr is very expensive, and that only large, corporate practices can afford them. i think the only way to reasonably determine how good any given patient's health care may be is to apply the same standard across the board. obviously one tool is the " how's your health " questionnaire, but there is another point the article makes which must be addressed-- are we smaller practices in fact prescribing the appropriate treatments for post-MI, post-stroke and diabetes, to name a few. certainly there must be a relatively simple search one can do with one's poor little emr, backward and inexpensive as it may be. i suspect the large corporate medical groups are scared of small groups and solo practitioners, and by quoting scattered statistics here and there, can sow fear and loathing of us. but then again, i wonder, if the large corporate insurance companies were only to contract with large corporate medical practices, using statistics such as this as their rationale, where will we be left? and if socialized medicine actually happens here in the US, do you think the government will want to contract with solo docs and small practices providing allegedly sub-standard care, or some large corporate entity who " can do it all " , supposedly with the outcomes to back it up? what do you think? LL Never miss a thing. Make Yahoo your homepage. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2007 Report Share Posted November 29, 2007 Straz, P4P is not as good as HYH. You could “trust me” on that or you can go through an IMP cohort (I would recommend the latter). I also disagree about the good doc/bad doc thing. I think most docs are good---they are usually just perverted by the terrible system in which they work. But, I wonder if anyone actually has a good study on this? Are good docs that way because of nature or nurture or a combination? amw news article very interesting. to my reading, there are several sets of statistics referred to in the article, each supporting different points, and none of which use the same statistical base. there are, i believe, four studies quoted supporting the idea that bigger is better, and one which supports smaller is better. there is no mention of where the surveyed doctor's practices are, urban, rural, suburban, what the patient's payer sources are, and what the patient's co-morbid conditions may be, along with socio-economic status, all of which may effect care and outcomes. the large, corporate model infers within-the-group referrals for specialty care and patient education, whereas a solo doctor may incorporate patient education into the encounter, and depend on a referral network for specialty care, over which the doctor has no control. it's also clearly stated that solo doctors must not be well-educated and practice a poor quality of medicine, if for no other reason than that they practice alone. although the practice of medicine has and continues to change, there are some fundamentals of health care and doctoring which haven't, and that's prevention. is it better to help prevent the heart attack or stroke, or to know the latest medication, shortly to be recalled by FDA? the article also infers that use of an emr is very expensive, and that only large, corporate practices can afford them. i think the only way to reasonably determine how good any given patient's health care may be is to apply the same standard across the board. obviously one tool is the " how's your health " questionnaire, but there is another point the article makes which must be addressed-- are we smaller practices in fact prescribing the appropriate treatments for post-MI, post-stroke and diabetes, to name a few. certainly there must be a relatively simple search one can do with one's poor little emr, backward and inexpensive as it may be. i suspect the large corporate medical groups are scared of small groups and solo practitioners, and by quoting scattered statistics here and there, can sow fear and loathing of us. but then again, i wonder, if the large corporate insurance companies were only to contract with large corporate medical practices, using statistics such as this as their rationale, where will we be left? and if socialized medicine actually happens here in the US, do you think the government will want to contract with solo docs and small practices providing allegedly sub-standard care, or some large corporate entity who " can do it all " , supposedly with the outcomes to back it up? what do you think? LL Never miss a thing. Make Yahoo your homepage. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2007 Report Share Posted November 29, 2007 I'm not sure I agree about the good doctors providing good care no matter what system they are working in. A corollary of this I think is true - it is much easier for 'good' and 'bad' doctors to provide great care in a system that is set up for great care, (it is the matrix and not the individual doctor) and the opposite of that - it is easily possible to give crappy care even if you are a 'good' doctor in say a system that only gives you 7.5 minutes to see your patient also seems true. How COULD you give great care in a system like that? You might be able to give passable care but it simply could not be as good as one where you actually knew your patient and were not emotionally completely exhausted from volume. The roots of the IMP project- time. Also the continuous improvement facet of using HowsYourHeath information is a second tier that allows correction of suboptimal care, now how can you lose? LynnTo: From: drbrady@...Date: Thu, 29 Nov 2007 13:04:05 -0500Subject: RE: amw news article Straz, P4P is not as good as HYH. You could “trust me” on that or you can go through an IMP cohort (I would recommend the latter). I also disagree about the good doc/bad doc thing. I think most docs are good---they are usually just perverted by the terrible system in which they work. But, I wonder if anyone actually has a good study on this? Are good docs that way because of nature or nurture or a combination? amw news article very interesting. to my reading, there are several sets of statistics referred to in the article, each supporting different points, and none of which use the same statistical base. there are, i believe, four studies quoted supporting the idea that bigger is better, and one which supports smaller is better. there is no mention of where the surveyed doctor's practices are, urban, rural, suburban, what the patient's payer sources are, and what the patient's co-morbid conditions may be, along with socio-economic status, all of which may effect care and outcomes. the large, corporate model infers within-the-group referrals for specialty care and patient education, whereas a solo doctor may incorporate patient education into the encounter, and depend on a referral network for specialty care, over which the doctor has no control. it's also clearly stated that solo doctors must not be well-educated and practice a poor quality of medicine, if for no other reason than that they practice alone. although the practice of medicine has and continues to change, there are some fundamentals of health care and doctoring which haven't, and that's prevention. is it better to help prevent the heart attack or stroke, or to know the latest medication, shortly to be recalled by FDA? the article also infers that use of an emr is very expensive, and that only large, corporate practices can afford them. i think the only way to reasonably determine how good any given patient's health care may be is to apply the same standard across the board. obviously one tool is the "how's your health" questionnaire, but there is another point the article makes which must be addressed-- are we smaller practices in fact prescribing the appropriate treatments for post-MI, post-stroke and diabetes, to name a few. certainly there must be a relatively simple search one can do with one's poor little emr, backward and inexpensive as it may be. i suspect the large corporate medical groups are scared of small groups and solo practitioners, and by quoting scattered statistics here and there, can sow fear and loathing of us. but then again, i wonder, if the large corporate insurance companies were only to contract with large corporate medical practices, using statistics such as this as their rationale, where will we be left? and if socialized medicine actually happens here in the US, do you think the government will want to contract with solo docs and small practices providing allegedly sub-standard care, or some large corporate entity who "can do it all", supposedly with the outcomes to back it up? what do you think? LL Never miss a thing. Make Yahoo your homepage. Connect and share in new ways with Windows Live. Connect now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 29, 2007 Report Share Posted November 29, 2007 There is quite a bit of literature on this. The best is to look over the executive summary of the Institute of Medicine's Crossing the Quality Chasm report: http://books.nap.edu/openbook.php?record_id=10027 & page=R1 Paraphrase: We have a system that has stretched " hard work " and " caring " and " professionalism " and " intelligence " to the limits. These necessary qualities are insufficient. To them we must add: " systems that support the desired outcomes. " As the report states: the current system is incapable of delivering the results we want and need. We need new systems. Translation: a good doc in a bad system gets bad outcomes. Executive summary opening paragraph: The American health care delivery system is in need of fundamental change. Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive (Donelan et al., 1999; and St. , 1997; Shindul-Rothschild et al., 1996; , 2001). The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits. and later: Health care has safety and quality problems because it relies on outmoded systems of work. Poor designs set the workforce up to fail, regardless of how hard they try. If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes. At 01:18 PM 11/29/2007, you wrote: I'm not sure I agree about the good doctors providing good care no matter what system they are working in. A corollary of this I think is true - it is much easier for 'good' and 'bad' doctors to provide great care in a system that is set up for great care, (it is the matrix and not the individual doctor) and the opposite of that - it is easily possible to give crappy care even if you are a 'good' doctor in say a system that only gives you 7.5 minutes to see your patient also seems true. How COULD you give great care in a system like that? You might be able to give passable care but it simply could not be as good as one where you actually knew your patient and were not emotionally completely exhausted from volume. The roots of the IMP project- time. Also the continuous improvement facet of using HowsYourHeath information is a second tier that allows correction of suboptimal care, now how can you lose? Lynn To: From: drbrady@... Date: Thu, 29 Nov 2007 13:04:05 -0500 Subject: RE: amw news article Straz, P4P is not as good as HYH. You could “trust me” on that or you can go through an IMP cohort (I would recommend the latter). I also disagree about the good doc/bad doc thing. I think most docs are good---they are usually just perverted by the terrible system in which they work. But, I wonder if anyone actually has a good study on this? Are good docs that way because of nature or nurture or a combination? amw news article very interesting. to my reading, there are several sets of statistics referred to in the article, each supporting different points, and none of which use the same statistical base. there are, i believe, four studies quoted supporting the idea that bigger is better, and one which supports smaller is better. there is no mention of where the surveyed doctor's practices are, urban, rural, suburban, what the patient's payer sources are, and what the patient's co-morbid conditions may be, along with socio-economic status, all of which may effect care and outcomes. the large, corporate model infers within-the-group referrals for specialty care and patient education, whereas a solo doctor may incorporate patient education into the encounter, and depend on a referral network for specialty care, over which the doctor has no control. it's also clearly stated that solo doctors must not be well-educated and practice a poor quality of medicine, if for no other reason than that they practice alone. although the practice of medicine has and continues to change, there are some fundamentals of health care and doctoring which haven't, and that's prevention. is it better to help prevent the heart attack or stroke, or to know the latest medication, shortly to be recalled by FDA? the article also infers that use of an emr is very expensive, and that only large, corporate practices can afford them. i think the only way to reasonably determine how good any given patient's health care may be is to apply the same standard across the board. obviously one tool is the " how's your health " questionnaire, but there is another point the article makes which must be addressed-- are we smaller practices in fact prescribing the appropriate treatments for post-MI, post-stroke and diabetes, to name a few. certainly there must be a relatively simple search one can do with one's poor little emr, backward and inexpensive as it may be. i suspect the large corporate medical groups are scared of small groups and solo practitioners, and by quoting scattered statistics here and there, can sow fear and loathing of us. but then again, i wonder, if the large corporate insurance companies were only to contract with large corporate medical practices, using statistics such as this as their rationale, where will we be left? and if socialized medicine actually happens here in the US, do you think the government will want to contract with solo docs and small practices providing allegedly sub-standard care, or some large corporate entity who " can do it all " , supposedly with the outcomes to back it up? what do you think? LL Never miss a thing. Make Yahoo your homepage. Connect and share in new ways with Windows Live. Connect now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2007 Report Share Posted December 2, 2007 Lynn, I couldn't agree more with you. Seven years ago I left a very large mullti specialty clinic in Seattle after 15 years, because of an " incentive program " which rewarded docs who saw 30+ patients a day by giving them 10% of what the docs that only saw 15-25 patients a day made. One day I saw as many as I could in 8 hours - 35! When I went home that night I cried because I was so worried that Mrs. would get confused and double-up her Lanoxin instead of her Lasix and be dead! Shortly thereafter I decided to return to a solo office practice and now see 10 patients a day, provide each of them with a printed copy of their chart note, which lists medications and any changes, and I am happier than I have been in the past 30 years as a doc. And I sleep well at night. Faster care does not = better care in my book either. Gallanis jgallanis@... > >Reply-To: >To: <practiceimprovement1 > >Subject: RE: amw news article >Date: Thu, 29 Nov 2007 13:18:21 -0500 > > >I'm not sure I agree about the good doctors providing good care no matter >what system they are working in. A corollary of this I think is true - it >is much easier for 'good' and 'bad' doctors to provide great care in a >system that is set up for great care, (it is the matrix and not the >individual doctor) and the opposite of that - it is easily possible to >give crappy care even if you are a 'good' doctor in say a system that only >gives you 7.5 minutes to see your patient also seems true. How COULD you >give great care in a system like that? You might be able to give passable >care but it simply could not be as good as one where you actually knew >your patient and were not emotionally completely exhausted from volume. >The roots of the IMP project- time. >Also the continuous improvement facet of using HowsYourHeath information is >a second tier that allows correction of suboptimal care, now how can you >lose? >Lynn > >To: >From: drbrady@... >Date: Thu, 29 Nov 2007 13:04:05 -0500 >Subject: RE: amw news article > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >Straz, > >P4P is not as good as HYH. You could “trust >me” on that or you can go through an IMP cohort (I would recommend the >latter). >I also disagree about the good doc/bad doc thing. I think most docs are >good---they are usually just perverted by the terrible system in which they >work. But, I wonder if anyone actually has a good study on this? Are good >docs that way because of nature >or nurture or a combination? > > > > > > >amw news article > > > > > > > > > >very interesting. > >to my reading, there are several sets of statistics referred to in the >article, >each supporting different points, and none of which use the same >statistical >base. > >there are, i believe, four studies quoted supporting the idea that bigger >is >better, and one which supports smaller is better. > >there is no mention of where the surveyed doctor's practices are, urban, >rural, >suburban, what the patient's payer sources are, and what the patient's >co-morbid conditions may be, along with socio-economic status, all of which >may >effect care and outcomes. > >the large, corporate model infers within-the-group referrals for specialty >care >and patient education, whereas a solo doctor may incorporate patient >education >into the encounter, and depend on a referral network for specialty care, >over >which the doctor has no control. > >it's also clearly stated that solo doctors must not be well-educated and >practice a poor quality of medicine, if for no other reason than that they >practice >alone. although the practice of medicine has and continues to change, >there are some fundamentals of health care and doctoring which haven't, and >that's prevention. is it better to help prevent the heart attack or >stroke, or to know the latest medication, shortly to be recalled by FDA? > >the article also infers that use of an emr is very expensive, and that only >large, corporate practices can afford them. > >i think the only way to reasonably determine how good any given patient's >health care may be is to apply the same standard across the board. > >obviously one tool is the " how's your health " questionnaire, but >there is another point the article makes which must be addressed-- are we >smaller practices in fact prescribing the appropriate treatments for >post-MI, >post-stroke and diabetes, to name a few. > >certainly there must be a relatively simple search one can do with one's >poor >little emr, backward and inexpensive as it may be. > >i suspect the large corporate medical groups are scared of small groups and >solo >practitioners, and by quoting scattered statistics here and there, can sow >fear >and loathing of us. > >but then again, i wonder, if the large corporate insurance companies were >only >to contract with large corporate medical practices, using statistics such >as >this as their rationale, where will we be left? > >and if socialized medicine actually happens here in the US, do you think >the >government will want to contract with solo docs and small practices >providing >allegedly sub-standard care, or some large corporate entity who " can do it >all " , supposedly with the outcomes to back it up? > >what do you think? > >LL > > > > > > > > > > > > > >Never miss a thing. Make Yahoo >your homepage. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ >Connect and share in new ways with Windows Live. >http://www.windowslive.com/connect.html?ocid=TXT_TAGLM_Wave2_newways_112007 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2007 Report Share Posted December 3, 2007 , Hello! from across the water! Dennis Galvon and Larry Lyon are over here with me in Kitsap County. I'm hoping we might get together sometime after the Christmas holidays for dinner (or nachos, whatever) and talk a little shop. Are you interested? Sujay Shlifer () Gallanis wrote: Lynn,I couldn't agree more with you. Seven years ago I left a very large mullti specialty clinic in Seattle after 15 years, because of an "incentive program" which rewarded docs who saw 30+ patients a day by giving them 10% of what the docs that only saw 15-25 patients a day made. One day I saw as many as I could in 8 hours - 35! When I went home that night I cried because I was so worried that Mrs. would get confused and double-up her Lanoxin instead of her Lasix and be dead! Shortly thereafter I decided to return to a solo office practice and now see 10 patients a day, provide each of them with a printed copy of their chart note, which lists medications and any changes, and I am happier than I have been in the past 30 years as a doc. And I sleep well at night. Faster care does not = better care in my book either. Gallanisjgallanis@...>From: Lynn Ho >Reply-To: >To: >Subject: RE: amw news article>Date: Thu, 29 Nov 2007 13:18:21 -0500>>>I'm not sure I agree about the good doctors providing good care no matter >what system they are working in. A corollary of this I think is true - it >is much easier for 'good' and 'bad' doctors to provide great care in a >system that is set up for great care, (it is the matrix and not the >individual doctor) and the opposite of that - it is easily possible to >give crappy care even if you are a 'good' doctor in say a system that only >gives you 7.5 minutes to see your patient also seems true. How COULD you >give great care in a system like that? You might be able to give passable >care but it simply could not be as good as one where you actually knew >your patient and were not emotionally completely exhausted from volume. >The roots of the IMP project- time.>Also the continuous improvement facet of using HowsYourHeath information is >a second tier that allows correction of suboptimal care, now how can you >lose?>Lynn>>To: >Date: Thu, 29 Nov 2007 13:04:05 -0500>Subject: RE: amw news article>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Straz,>>P4P is not as good as HYH. You could “trust>me” on that or you can go through an IMP cohort (I would recommend the >latter).>I also disagree about the good doc/bad doc thing. I think most docs are>good---they are usually just perverted by the terrible system in which they>work. But, I wonder if anyone actually has a good study on this? Are good >docs that way because of nature>or nurture or a combination?>>>>>> >amw news article>>>>>>>>>>very interesting.>>to my reading, there are several sets of statistics referred to in the >article,>each supporting different points, and none of which use the same >statistical>base.>>there are, i believe, four studies quoted supporting the idea that bigger >is>better, and one which supports smaller is better.>>there is no mention of where the surveyed doctor's practices are, urban, >rural,>suburban, what the patient's payer sources are, and what the patient's>co-morbid conditions may be, along with socio-economic status, all of which >may>effect care and outcomes.>>the large, corporate model infers within-the-group referrals for specialty >care>and patient education, whereas a solo doctor may incorporate patient >education>into the encounter, and depend on a referral network for specialty care, >over>which the doctor has no control.>>it's also clearly stated that solo doctors must not be well-educated and>practice a poor quality of medicine, if for no other reason than that they >practice>alone. although the practice of medicine has and continues to change,>there are some fundamentals of health care and doctoring which haven't, and>that's prevention. is it better to help prevent the heart attack or>stroke, or to know the latest medication, shortly to be recalled by FDA?>>the article also infers that use of an emr is very expensive, and that only>large, corporate practices can afford them.>>i think the only way to reasonably determine how good any given patient's>health care may be is to apply the same standard across the board.>>obviously one tool is the "how's your health" questionnaire, but>there is another point the article makes which must be addressed-- are we>smaller practices in fact prescribing the appropriate treatments for >post-MI,>post-stroke and diabetes, to name a few.>>certainly there must be a relatively simple search one can do with one's >poor>little emr, backward and inexpensive as it may be.>>i suspect the large corporate medical groups are scared of small groups and >solo>practitioners, and by quoting scattered statistics here and there, can sow >fear>and loathing of us.>>but then again, i wonder, if the large corporate insurance companies were >only>to contract with large corporate medical practices, using statistics such >as>this as their rationale, where will we be left?>>and if socialized medicine actually happens here in the US, do you think >the>government will want to contract with solo docs and small practices >providing>allegedly sub-standard care, or some large corporate entity who "can do it>all", supposedly with the outcomes to back it up?>>what do you think?>>LL>>>>>>>>>>>>>>Never miss a thing. Make Yahoo>your homepage.>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>_________________________________________________________________>Connect and share in new ways with Windows Live.>http://www.windowslive.com/connect.html?ocid=TXT_TAGLM_Wave2_newways_112007 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2007 Report Share Posted December 7, 2007 , Lynn and , I'll take your word on it. My point is that any statistical evaluation is always subject to criticism depending upon your point of view. I'm just a skeptic, I guess. Good/bad doctor is poor wording on my part. More accurately, there are better docs and worse docs, just as there are better/worse cooks. In a better kitchen the overall quality of the food should improve from both cooks, but in most cases the better cook will produce better meals. As an urgent care doc, I give a lot of fast care, when appropriate. I also slow down when needed. If anyone is familiar with wave-type scheduling, walk-in urgent care is an extreme form of that. Typical sequential scheduling of an appointment every 10-20 minutes doesn't allow for the shrinkage and expansion of face time with the patient that's dependant on the complaint and initial assessment. I know I'm going to have some patients that take longer than expected; by keeping uncomplicated visits short I build in a cushion of time for the complicated patient. During the periods, when nothing unexpected happens, I get a few minutes to decompress with the paper, a little paperwork, etc. When I was in a typical family practice office, the problem I had with usual office scheduling was that when the unexpected, but commonly occurring, long visit (or late patient) came along, there was no way to make up the time that was necessarily spent with that patient. So you begin to run late and then patients are irritated, you're rushed and the patient/doctor relationship suffers. I'll agree that faster care is probably not better care. But faster care can be equivalent care, particularly for acute problems. And these days, patients appreciate the convenience of knowing they will not be in a doctor's office longer than 30-40 minute for a simple problem. Straz Charlottesville, VA >amw news article > > > > > > > > > >very interesting. > >to my reading, there are several sets of statistics referred to in the >article, >each supporting different points, and none of which use the same >statistical >base. > >there are, i believe, four studies quoted supporting the idea that bigger >is >better, and one which supports smaller is better. > >there is no mention of where the surveyed doctor's practices are, urban, >rural, >suburban, what the patient's payer sources are, and what the patient's >co-morbid conditions may be, along with socio-economic status, all of which >may >effect care and outcomes. > >the large, corporate model infers within-the-group referrals for specialty >care >and patient education, whereas a solo doctor may incorporate patient >education >into the encounter, and depend on a referral network for specialty care, >over >which the doctor has no control. > >it's also clearly stated that solo doctors must not be well-educated and >practice a poor quality of medicine, if for no other reason than that they >practice >alone. although the practice of medicine has and continues to change, >there are some fundamentals of health care and doctoring which haven't, and >that's prevention. is it better to help prevent the heart attack or >stroke, or to know the latest medication, shortly to be recalled by FDA? > >the article also infers that use of an emr is very expensive, and that only >large, corporate practices can afford them. > >i think the only way to reasonably determine how good any given patient's >health care may be is to apply the same standard across the board. > >obviously one tool is the " how's your health " questionnaire, but >there is another point the article makes which must be addressed-- are we >smaller practices in fact prescribing the appropriate treatments for >post-MI, >post-stroke and diabetes, to name a few. > >certainly there must be a relatively simple search one can do with one's >poor >little emr, backward and inexpensive as it may be. > >i suspect the large corporate medical groups are scared of small groups and >solo >practitioners, and by quoting scattered statistics here and there, can sow >fear >and loathing of us. > >but then again, i wonder, if the large corporate insurance companies were >only >to contract with large corporate medical practices, using statistics such >as >this as their rationale, where will we be left? > >and if socialized medicine actually happens here in the US, do you think >the >government will want to contract with solo docs and small practices >providing >allegedly sub-standard care, or some large corporate entity who " can do it >all " , supposedly with the outcomes to back it up? > >what do you think? > >LL > > > > > > > > > > > > > >Never miss a thing. Make Yahoo >your homepage. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ >Connect and share in new ways with Windows Live. >http://www.windowslive.com/connect.html?ocid=TXT_TAGLM_Wave2_newways_11 2007 Quote Link to comment Share on other sites More sharing options...
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