Tuesday, August 18, 2009
Conversation with a Doctor
My brother Al is a doctor who thinks that a single-payer health care system is the only answer and is not too impressed with Obama's so-called plan.
He gave me several examples where evidence-based medicine (referred to as "rationing" by the opponents of reform) could save alot of money. Pointless MRI's for one. But there is no consistent mechanism to restrain doctors from ordering them.
Doctors should be salaried, and the huge expense of training distributed in a way that better encourages frontline practices rather than drawing doctors into lucrative specialties, or to elite institutions which can afford to pay the debt for them.
In the St. Louis area training of support personel in medical services is made difficult by lack of teamwork experience in Secondary Schools. We didn't discuss specifics but its probably "Bossism" that wrecks the ship. Authoritarian rather than democratic work norms and processes. Like in American industry- the lower the level the decision can be made the more effective the outcome. An experienced hand who has worked his way up from the shop floor is better than an MBA any day.
A person who has only learned to take orders "from the top", is wary of taking initiatives and laterally uncommunicative is a drag.
The network of individuals who have been trained in socially cohesive work paradigms, however, extends far beyond a specific work place into the industry and community as a whole. This, in and of itself, has positive epidemiological consequences for health.
My brother has supported Medecins Sans Frontieres for thirty years.