Chatters From the world of medicine 2014

The possible seismic effect of the Affordable Care Act (ACA) is the talk of the nation. The mood is predictably subdued. Some great doctors are overheard ruing their decisions to go to medical school; others are anxious, wondering whether more “catastrophic” events would follow. It is unsettling to those at the prime of their medical careers while challenging to those who are just starting. Although the full impact of the ACA would not be fully felt, perhaps, for another decade, the sad truth is that healthcare, as we know it, would never be the same.

Doctors Seeking Hospital Employment:

There is a rush on the part of many physicians to abandon the idea of private practice in favor of obtaining hospital employment. This is understandable in the face of a widening inverse relationship between soaring overhead expenses and reimbursements. In the past few years, there was a proliferation of hospitalists-doctors employed by hospitals to tend to hospitalized patients after regular office hours and weekends. Although physicians acknowledge losing some autonomy, hospital employment is a humane alternative to the untenable demands of private practice. Unfortunately, economic volatility and the anticipated profound impact of the ACA on hospitals make job security just as tenuous as any job in the market. Can anybody imagine physicians getting unemployed? Hopefully, these uncertainties would not ultimately compromise patient care.

Screening for Lung Cancer:

The foremost cause of cancer death for both men and women in this country is lung cancer. Is there a screening test for this disease similar to mammography or colonoscopy? This issue has been a focus of research for a period time as patients beg for an answer.

Finally, Med Page reported on its Dec. 30, 2013 issue that the U.S. Preventive Services Task Force (USPSTF) approved the recommended use of low dose CT for lung cancer screening.

Who are eligible for screening? Those adults ages 55 through 79 with 30 pack-year history of smoking or who have quit in the past 15 years. However, it is still strongly emphasized that only cessation of smoking can prevent lung cancer.

Medical School Innovations:

It is sensible to assume that for our health care system to remain the envy of the world, all “players” should be involved in effecting change. During my many years of training, nobody ever suggested that the health care system was flawed. Medical education in general and surgical training, in particular, focused mainly in producing the best doctors. Trainees were admonished to not let “politics or money interfere with the practice of good medicine.”

At the end, physicians expected to earn a decent living but nobody explained that it would be more intricate than the actual saving of lives. Then, suddenly, the US healthcare system is “the most expensive yet least effective.”

Today, the rest of the story is the inevitability of change! The AMA Wire News reported that eleven leading medical schools in the country have been given grants to find answers to these challenges. The preliminary reports indicate that medical schools are introducing innovative changes in their curricula; changing the way they teach students how to become the healthcare providers of the complex healthcare system of the future. In essence, the new curricula envision making the medical students integral part of the total health care system from day one.

“We want them to help solve the problem that we are all facing,” says Dr. Maryellen Gusic of the Indiana University School of Medicine.

HAPPY NEW YEAR!

Dr. Cabasares is a board certified general surgeon and Fellow of the American College of Surgeons; he practices in Perry.

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