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EditorialDo We Need A New Approach To Medical Care?Niranjan Kissoon, M.D., Editor |
| "The provision of medical care has become one of the largest industries in the country. Within the lives of many now living, revolutionary changes in science have transformed medicine from a comparatively simple field into a complex domain…until recently, people…rested content because medicine is in good hands, but the unprecedented growth of medicine, the enormous expansion of personnel and facilities, the investment of billions of dollars have created issues from which society cannot escape merely through its own optimism or through confidence in the high character of medical practitioners." This statement by Ray Lieman Wilbur, MD, Chairman of the Committee on Costs of Medical Care in 1933 has not outlived its relevance and holds true for today. It seems therefore, that we need to revisit our approach to the provision of medical care as knowledge increases exponentially and is now at the fingertips of anyone with access to a computer and the Internet. A first step is parting ways with the paternalistic doctor-patient relationships of the past and embracing a new dawn in which the patient is a partner in rather than a recipient of care. It involves integrative medicine, science wedded to compassion and art in its purest form. It includes the embracing of technology and informatic systems not to replace medical personnel, but to enlarge the perimeter of our influence and therapeutic armamentarium. However, according to science historian, Thomas Kohn, a new way of looking at the world succeeds only when the old way painfully and obviously fails. Has the old way of paternalism and self-professed "best care" painfully and obviously failed? We still enjoy a privileged position and the confidence of our patients, but paternalism is viewed less favorably. There are however, no simple answers as to whether we provide the best care for our patients. Some colleagues feel that clinging to the notion of providing the best care is perilous in the present climate. They are therefore anxiously scanning the horizon for a better way to deliver "quality" care. On the other hand, there are those who feel that the system has not failed, and are anxious to circle the wagons against all odds. These naysayers claim that the United States has "the best medicine in the world". However, there is evidence suggesting that we may have the best medical advances and technology, but this has not translated into the "best health" or "best quality and value". As medical practitioners we have to decide whether we intend to be pragmatics or ostriches. The cogent issue is whether our present system of healthcare is as good as it can be. A dispassionate appraisal will be the first step in deciding whether changes are necessary. Physicist Max Plank wrote "a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it". I trust that the medical profession searches vigorously for and champions new truths rather than wait for death or retirement. Shouldering of our responsibilities will relieve this burden for the next generation of physicians. Jacksonville Medicine / April 2000 What's New
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