Berks County Medical Society Medical Record Fall 2018 - 5

editorial comments

"What the
Patient Needs
is a Doctor"
by Lucy J. Cairns, MD

T

he renowned physician and educator Eugene A. Stead Jr.
(Chair of the Department of Medicine at Duke from 19471967 and founder of the Physician Assistant profession) had
strong opinions regarding the training of doctors and the practice
of medicine. The quote above is among the statements he repeated
often enough that they became known as "Steadisms" and collected
in the book Just Say for Me. This particular quote was his way of
emphasizing the importance to a patient of having a physician take
ownership of their care, rather than a somewhat disjointed collection
of specialists. The question of exactly what should constitute
"ownership" of patient care is examined in a much broader context
in this edition's feature article by the 2018 BCMS President's Intern
Jerry Zhu: "Health Determinants Beyond the Exam Room."
The major determinants of health fall under five broad domains:
biology and genetics, individual behaviors, social environment,
physical environment, and health services. The fact that the
health service domain (access to and quality of health care) has a
small impact on health relative to the other determinants is old
news. What is coming under increasing scrutiny is how much
responsibility for addressing the other determinants of health
should be assigned to physicians, and what such "ownership" might
look like. The argument in favor of having physicians pay more
attention to factors which may be given short shrift in the typical
patient history note is straightforward: detailed knowledge of a
patient's social and physical environments, employment history,
education, and economic status can be used to tailor health care
recommendations for maximum effectiveness.

There was a time in the history of medical practice-which
some physicians still alive today can remember-when most doctors
were generalists and long-term members of the community they
served. Such generalists provided care for all but the most severe
or unusual problems, and intimate knowledge of their patients'
life circumstances was the rule. During the past century care has
become more fragmented with the rise of specialization, and the
relationship between physicians and patients has also suffered from
certain aspects of the shift from the cottage-industry model of care
to more of a factory-industry model. In the factory-industry model
of health care there has been a strong emphasis on efficiency, driven
by a fee-for-service payment structure which has rewarded primary
care physicians based on the volume of patient visits rather than
the patients' health outcomes. Physician reimbursement levels that
have not keep pace with increases in overhead costs have added
to the pressure to generate income by seeing more patients in
less time, and the advent of electronic record systems designed to
require physicians to perform time-consuming data input during
patient visits has further reduced the amount of time doctors have
to interact with patients. The end result has been that time to get
to know a patient's life circumstances in any detail has been largely
squeezed out of the typical office visit.
continued on next page >

FALL 2018

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Berks County Medical Society Medical Record Fall 2018

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Fall 2018

Berks County Medical Society Medical Record Fall 2018 - 1
Berks County Medical Society Medical Record Fall 2018 - 2
Berks County Medical Society Medical Record Fall 2018 - 3
Berks County Medical Society Medical Record Fall 2018 - 4
Berks County Medical Society Medical Record Fall 2018 - 5
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