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Editorial APRIL
2009
The Challenges
of Change
Ronald T. Burkman, MD
As I listened to President Obama’s recent speech to the nation and Congress,
it was clear change was in the air. Some of these changes also come with substantial
challenges.
At The Female Patient, change
is also underway. I have been named Editor-in-Chief, replacing Vivian Dickerson,
MD, who has decided to pursue other interests. She spent 3 years in this post,
and 8 years on our board. She
certainly will be missed.
In addition to having served on the board of The Female Patient for 10 years,
my background is that of
a generalist academician with
faculty appointments at Johns Hopkins, the University of Michigan via Henry
Ford Health System, and, most recently, at the Tufts University School of Medicine
at its Western Campus at Baystate Medical Center. Although I teach students
and residents and am involved in contraceptive and obstetric research, I still
actively practice as a generalist, including a healthy dose of obstetrics.
And, despite our recent challenges relative to reimbursement and the cost of
liability insurance, I have never regretted my decision to go into the field.
(My daughter closely examined my lifestyle, however, and decided not to follow
in my footsteps, choosing psychiatry instead.)
What are some of the challenges or opportunities facing us? Certainly one will
be the planned reformation of the health system proposed by President Obama.
The suggested changes will not be easy. There are almost 47 million Americans
currently without heath insurance. To eliminate this problem, the President
has announced that one of his goals is to achieve universal health care in
his first term. This goal, if pursued, will perhaps be
the greatest challenge faced by the new administration. Most would acknowledge
that we spend far too much of our health care dollars on administrative costs.
Reforming this aspect of the system would require either a total overhaul of
the way current insurers do business, or the introduction of a single payor
system. While a worthwhile goal overall, both approaches will face objections
from groups whose own interests are at stake.
The President also called for the curing of cancer in our lifetime. Although
a laudable goal, the complex interaction of genetics, risk factors, and multiple
putative agents will make this goal an immense and probably unattainable challenge.
Furthermore, mustering the resources necessary to at least partially achieve
this goal will be costly in terms of scientific manpower as well as dollars.
Significant cost will also accompany the introduction of electronic medical
records. The ability to send electronic prescriptions and access legible patient
information (not dependent on deciphering handwriting) should substantially
reduce errors, but the installation of current electronic medical products
is expensive. Hospital or health care systems, at least in the not-too-distant
past, have been able to absorb these costs—but for many private
practices, they will be prohibitive. Another “cost” is the decreased
productivity during
the learning curve to adapt to
a new system. Having gone through the introduction of 2 electronic medical
record systems during the past decade, I can assure you this is a real concern.
Finally, to be truly useful across the nation, electronic medical record systems
will need to “talk” to each other, a reality not currently in place
for the most part. Thus, a significant amount of time, effort, and expense
will need to go into the development of software that will interconnect systems,
and some type of universal standard.
Another aspect of health care reform being discussed is increased use of “new
technology.” The increasing use of endoscopic approaches to carry out
a substantial proportion of gynecologic surgery has decreased length of stay
and morbidity in most cases. However, the introduction of much of the new technology,
even smaller items, is not always accompanied by a cost-benefit analysis. I
can remember instances when certain laparoscopic instruments were stocked on
the basis of
1 or 2 surgeons’ preference at substantial cost over the status quo without
a clear improvement in outcome. Thus, as part of our evaluation of new medical
technology, we will have to be serious about including cost analysis along
with risks and benefits as one of the major factors in our decision-making
process.
We will discuss issues such as these from time to time on our editorial and
ViewPoint pages of The Female Patient, but the journal’s primary focus
will continue to be providing clinically relevant articles with the intent
of helping health care professionals practice evidence-based medicine that
meets the needs of our patients. In addition, some articles may address the
business of medicine or issues of concern, such as medical liability. Please
feel free to write me with your suggestions—we are always open to reviewing
new ideas. Finally, to paraphrase the President, although the times are trying,
we will prevail.
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Ronald T. Burkman, MD, Editor-in-Chief |
