• rss
  • facebook
  • twitter
  • linkedin

State of the Nation's Health Care Presentation 2005

by Charles Francis, MD, FACP, FACC
President, American College of Physicians

Good morning and welcome.

It's always an honor and a privilege to share the concerns of doctors of internal medicine with the news media. Physicians are responsible for providing the best health care possible to our patients. And you are responsible for informing the public of these important issues.

Your role is crucial and I thank you for taking the time to attend this briefing.

Medicine has always been beset by a multitude of both opportunities and challenges. But perhaps few have been as crucial as today. We are on the threshold of an almost revolutionary change in the way health care is delivered in this country. This change will mean a higher quality of care for patients, while simultaneously making better use of society's scarce resources.

This change, in its basic concept, is simple. The health care community will put information technology to work to improve the quality of care, institute ongoing quality improvement measures and save money at the same time. This approach relies on sound methods that have already been implemented in almost every other sector of the U.S.

The successful implementation of this effort rests on two key elements.

The first involves the need to fix the dysfunctional payment systems used by Medicare and most other payers. Unless Congress and the administration act soon, physicians will face crippling cuts in the pay they receive for treating Medicare patients.

This reduction will hinder physicians' ability to provide what they most value: the best possible care for their patients. The end result will be medical practices that must either reduce, or else eliminate entirely, the number of Medicare beneficiaries they see.

It also bodes ill for the ability of physician practices to acquire the expensive health information technology systems so vital to bringing about needed changes.

The second involves the need to create incentives for practice innovation and improvement. These innovations include the use of electronic health records and other types of health information technology. Such technology aims to support evidence-based practice improvement.

As reporters covering health policy, I'm sure you are aware that the treatment and outcomes for any specific disease or condition can vary greatly among different sections of the country. Or for that matter, even among different practices and hospitals in the same city.

The use of health information technology will give physicians clinical decision support tools at the point of care. For example, a physician treating a patient, whether in the emergency room or a private office, could instantly have access to their past medical history. In addition, a clinical decision support tool would quickly provide the best procedures and treatments available based on the latest scientific evidence.

Congress and the administration should also promote the use of new practice models to improve the coordination of care of patients with chronic diseases. Current Medicare payment policies favor episodic treatment of patients with acute illnesses. This archaic approach needs to be replaced with policies that support the physician's roles as the patient advocate and coordinator of quality care for patients with chronic diseases.

I'll leave it to my colleague Bob Doherty to explain in more detail our plan to achieve this goal.

I just want to make one crucial point from my perspective as a physician. During today's discussion you may hear a dizzying array of acronyms and jargon.

Through it all, though, I urge you to keep in mind the most important element of the health care system. And that element is the physician-patient relationship.

Nothing can take the place of the trust a patient places in a physician that he or she has seen for years. And I'm not talking about trust based on the fact that the person is a doctor. I mean the trust you put in another human being you tell the most intimate details of your life. You give them this trust because you know they have no other motive other than to help you.

And on the physician's part it involves the trust he has that the patient will follow his recommendations and that his guidance is valued.

Nothing can replace the unique knowledge a physician has about his patient based on years of visits and discussions. This doesn't concern just physical knowledge. It's equally important to have a prior understanding of a person's lifestyle, their moods, their likes and dislikes, and a hundred other elements that make every human life so unique and so priceless.

A physician typically knows from personal experience that one patient is extremely conscientious about adherence to a prescribed course of medical treatment. But for another patient, you may know equally well that considerable follow up is crucial to making sure the treatment plan is being followed.

This knowledge will never fit neatly into any kind of database. It can only be derived from the unique relationship that grows between a patient and a primary care physician over time.

If there is one crucial concept you take away today, I hope this is it.

The unique physician-patient relationship must be preserved at all costs.

If health information technology helps improve the physician-patient relationship it will accomplish wonders. But if not, the expected gains from such will never materialize. In fact, the practice of medicine will actually have taken a step backward.

Correct implementation is the key to making gains and ensuring they last.

Again, thank you. Now we'll be hearing from Bob Doherty.

ACP Policies and Recommendations

This library is a collection of ACP's Clinical Guidelines, Ethical Guidelines, Policy Statements, and copies of testimony and letters to government and non-government officials.

The ACP Advocate Blog

The ACP Advocate Newsletter