Medical Practice - Page 6
ACCOUNTABILITY
Over the past several decades, there have been
increased demands that physicians
account for the way in which they practice by
meeting certain federal and state stan-
dards. The hospitalization of patients whose
care is funded by the government is subject
to utilization review. This procedure requires
the physician to defend the reason for the
patient's hospital stay if it extends beyond the
established average standard. Elective
surgery, in some cases, requires a second
opinion. The purpose of these regulations is to
try to limit the high cost of health care.
Probably, all aspects of medical practice will in
time be subjected to this type of review, which
will profoundly alter medical practice.
Other approaches that may be used to judge
continuing competence of physicians
are an assessment of continuing education,
auditing patients' records, reexamination for
recertification, and time-limited certification
as a prerequisite for relicensing. Such
requirements clearly improve a physician's
factual knowledge, but it is uncertain if they
similarly effect the quality of
practice.
GUIDELINES TO PRACTICING MEDICINE
Physicians have at their disposal a large
number of diagnostic techniques and therapeu-
tic modalities. The challenge is to select the
most appropriate and cost-effective
approach for the specific patient and that
clinical condition. Formal clinical practice
guidelines are being developed by government
and professional organizations. These
guidelines ensure that no patient, regardless
of financial status, receives substandard
care; protection is provided to the physician
against inappropriate malpractice charges;
and the insurance company is protected against
excessive use of medical resources.
There are, however, negative aspects to the use
of guidelines. There may be major dif-
ferences of opinion on the routine use of
certain procedures, such as mammography.
Guidelines, by being broadly applicable, cannot
take into account the genetic and envi-
ronmental effects on individuals. Therefore,
the key is to utilize the guidelines as a
meaningful framework while maintaining the
flexibility to judge each case in the overall
context of the reasonable standards set by
knowledgeable clinicians. Under these cir-
cumstances, medicine will remain a learned
profession rather than a mere technical
vocation.
Cost Effectiveness in Medical Care
With the spiraling cost of health care, it is
necessary to establish priorities as to how
money is allocated. There is a greater emphasis
today on the prevention of diseases.
There is much that physicians can do to foster
cost control but socioeconomic concerns
should not interfere with the welfare of the
patient.
TEACHING AND RESEARCH
It is obligatory for physicians to share their
knowledge with colleagues, medical stu-
dents, and members of the allied professions.
Advances in medical knowledge depend
on acquiring new information from various types
of research, both basic and clinical.
Publicizing this information can bring about
improved medical care. Where appropriate,
physicians should encourage participation in
ethical clinical investigations.
Examples of preventive health measures include
immunization for a variety of
childhood diseases, mammography and Pap smears
for women to screen for breast and
uterine cancer, colonoscopy and PSA testing
(for men) to screen for colon cancer and
prostate cancer, and influenza immunization for
all patients over 50 as well as those
patients with chronic diseases such as diabetes
and hypertension. Such an approach can
be most beneficial to long-term health,
however, many private health insurers are not
yet promoting this approach to health care, in
spite of its undeniable benefits.
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