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From: xxxxxxxxxxxx@pol.net
Sent: Tuesday, January 29, 2008 1:28 AM
To: newsletter@medicaltraveltoday.com
Subject: Re: This Week in Medical Travel Today Vol2 Issue 9 |
| As a physician, I read the interviews with great interest and came away with a disturbing fact. No where, until you get to Ira Nissel and IMS Global does anyone stress anything but cost savings. Sure the quality of care by a US trained physician in India or Korea might be at the level that can be obtained at home, but aftercare, the possibility of severe complications and need for further intervention are never mentioned. What has been the hallmark of exceptional care for the 50 years I have been a physician has been the continuity of care, a fact that doesn't seem to exist in our "cost savings at any cost" mentality. Knowing your patient, having developed a mutually beneficial relationship over many years immediately provides the treating physician that provides an incalculable benefit to that patient's care. |
| What happens to a person who has a liver or heart transplant overseas, comes home in stable condition, but suddenly goes into acute rejection. Does he get on a plane back to where the surgery was performed, or does he then see a doctor who has never seen him, might have different thoughts on treatment, and has no real-time opportunity to discuss it with the original surgeon. Add this to the fact that the physician suddenly thrust into the therapeutic mix, might be averse to get involved since he was never able to be the doctor on the case. How would you as a physician feel if you got a call saying that I was in India for my heart transplant, but now that I am home, you need to take care of me because I now have complications. I might just say "sorry, I can't or won't help you. I don't want to be responsible if anything further goes wrong. I will probably get sued." |
| The fact that primary care physicians at many hospitals are being replaced by "Hospitalists" not because they are better doctors, but because they can provide cost savings, and not necessarily better care as documented by a recent article in the NEJM. |
| The tragedy confronting my profession is that the mantra of "who can do it cheaper, not who can do it better" reverberates throughout our health care system. Should the delivery of care be an investor owned, bottom line driven and Wall St sensitive industry? Have we forgotten that the best care is the least expensive care in the long run? The only one of the four entities involved in the delivery of care is the insurance industry, as they are the only one guaranteed to make a profit by reducing reimbursement to the physician, reduce services to the patient, and increasing premiums to the employer. It turns my stomach when I hear that Insurance Company A had a 15% increase in profits and that the recently replaced CEO had a separation package of over $200 million dollars. |
| What has happened to our value system? We have an industry (I cannot call it a profession) now based on fear and greed. What has happened to the value of education, training, knowledge, commitment, sensitivity, experience, honesty, morality and integrity? Caring has been replaced by what is the ROI, positive cash flow and all the other phrases that used to be relegated to the business world. |
Ira Nissel's efforts are the only patient sensitive ones in your entire article and interviews. And it is because his work is to provide care for those children who would otherwise not be able to receive it. To put his work in the same category of your other interviewees does him a great disservice.
Can we ever return to the time when doctors follow the following rules: Do the right thing to the right patient for the right reason in the right place at the right time and for the right price? |
| At a time when the brilliant discoveries and advances in medical science at at their zenith, to have a delivery system that is in such disarray that many physicians are discouraging their own children from pursue a career in medicine. What a shame. |
Robert I. Kramer, MD FAAP
Clinical Professor of Pediatrics and Pulmonology (ret)
UT Southwestern Medical Center
Dallas, Texas |
| You may publish this as you see fit. It is time that physicians retake the authority as well as the responsibility for health care. We can only do it if we begin to monitor, discipline and police ourselves. We must return to a value system that is based on integrity and honesty, not on avarice and greed. |
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