Читать книгу The Coming Healthcare Revolution: Take Control of Your Health - Sheldon Cohen M.D. - Страница 3

President Barack H. Obama

The White House

1600 Pennsylvania Ave

Washington DC 20500

Dear Sir:

I am an internist who was involved in direct patient care for forty years (biographic sketch enclosed). I am in favor of your efforts to expand healthcare to every citizen. The goal of eliminating or reducing the financial nightmare that many of us face is a laudable one. Seeking input from all stakeholders and listening to all viewpoints is necessary and commendable.

I do have concerns however. If we are to add the forty-seven million uninsured citizens to an already overburdened healthcare system, we may face a disaster of major proportions. Here are the reasons: The diminishing cadre of primary care physicians, already insufficient to provide for the current patient population, will not be enough to carry the sudden burden of an increased patient load. They are so busy involved in acute and chronic follow-up care that they have precious little time for one of the cornerstones of medical practice: the complete medical examination (a full and comprehensive medical history, a head to toe physical examination and basic laboratory analysis). Failure to diagnose has been one of the unfortunate results. There is nothing more important to the practice of medicine than this initial physician-patient interaction. Because of this shortcoming, another cornerstone of medical practice, prevention and early detection, has also suffered. Physicians have precious little time to concentrate on this crucial aspect of medical care. I agree with your emphasis on prevention and early detection—and it must be a priority in any future healthcare system.

Now that I have pointed out a few of the problems, I would be remiss if I did not offer solutions. You are aware of the shortage of primary care physicians. Patients need more of these dedicated physicians. We must build the foundation to accommodate this increasing patient load as soon as possible consistent with the tenets of good medical practice

Physicians will need assistance to carry out the cornerstones of medical practice described above. There is no reason why well-educated nurses and physicians assistants cannot perform the complete medical examinations and provide the counseling necessary to carry out early detection and prevention. I worked with nurses in this capacity and I can attest to the fact that they were exceptional. With the physician as captain of this ship, freed up to concentrate on acute and follow-up care and the more urgent and serious cases, every office can become a complete physical examination, risk factor analysis and early detection and prevention center as well as an acute and chronic primary care office. I leave it to the economists to determine reimbursement mechanisms.

I also suggest that physicians, nurses, physician assistants and other healthcare workers need protection from the avalanche of malpractice lawsuits that are overwhelming the system. This will require modification of your stance on tort reform. When I was consulting in Europe (see biographical sketch), I asked the physicians how malpractice was handled. They replied that there is a mediation board set up to take care of the patient’s present and future needs. I believe an approach of this sort is necessary if you want the support of the healthcare community.

Thank you for your attention.

Wishing you success in your efforts, I am sincerely yours,

Sheldon Cohen M.D. FACP

I wrote this letter to the president while he was waiting for a healthcare bill to be on his desk “by the end of the week.” I believe most physicians share the sentiments expressed in my letter. I received a Dear Friend thank you note signed by the president. Subsequent events put roadblocks in the plan, but I am hopeful for a solution. Time will tell what form it takes. Patients must be prepared to take control. It is hoped that this book will show them why it is important to do just that, plus provide some education about the complexities of the art and science of medical practice and the patient’s role in helping to make it as fool-proof as possible.

FROM THE AUTHOR…ABOUT THIS BOOK:

I write books as a hobby and in an effort to stay abreast of medical issues, a daunting task in these days of rapid medical advances. Writing also helps to keep one’s mind mentally stimulated as old age slowly and inexorably creeps up. That plus physical exercise (I walk a dog every day) gives me a leg up on prevention according to well-accepted research.

I write in many different genres including medical non-fiction, medical fiction, World War II and Jewish historical fiction, terrorism, and have written a series of short books with many different sub-titles under the heading of The Slim Book of Health Pearls.

Healthcare in the United States is now on the threshold of a major historical change. Obamacare, or the Patient Protection and Affordable Care Act will require much more of patients now suddenly thrust upon an already overburdened and overcrowded medical care system. It becomes more important than ever to TAKE CONTROL OF YOUR HEALTH!

With this in mind, and in view of the above impending changes, I decided to take four of my Slim Book of Health Pearls series and incorporate them into one book, all with the goal of assisting the patient in the daunting task of navigating through the coming healthcare changes and taking appropriate steps to control risk. The four steps are:

1.The Prevention of Medical Errors…Step 1

2.The Complete Medical Examination…Step 2

3.Risk Factor Analysis and Health Screening…Step 3

4.Symptoms Never to Ignore…Step 4

As a patient, your role in navigating through these four headings is crucial because.

•Medical errors are pervasive and dangerous and can injure or kill. You need to know what they are in order to take preventive measures.

•The complete medical examination in today’s medical environment is often incomplete and the source of many failure to diagnose malpractice law suits. You need to know what the complete exam entails and insist on its implementation.

•Risk factor analysis and health screening is a crucial part of an initial patient evaluation, but is often incomplete or ignored. Patients can perform this important risk factor analysis on their own and learn the proper timing of health screenings.

•Patient delay in evaluating symptoms is a dangerous procrastination that you must avoid.

The book will amplify each section in detail.

I would be remiss if I did not add one personal warning about the coming healthcare system. Tort reform, in the new healthcare changes to be, is conspicuous by its absence. As the thousands of pages of changes come into effect, and as more and more physicians abandon private practice to take on salaried roles, and as the medical system in the United States approaches the more socialized system of other countries, which I firmly believe is inevitable, the absence of tort reform, similar to the system of other countries poses the risk of collapsing the system, both medically and financially.