The challenge

Article Abstract:

The practice of medicine is in the process of a major transition, in large part due to advancing technology and the proliferation of huge amounts of information. Consequently the intellectual foundation of medical care has been seriously challenged by questioning the previous assumption that the doctor is always right. This challenge to the quality of clinical decisions made by physicians is well founded. An example which illustrates this problem is given. Four cardiologists were asked to evaluate the results of high-quality coronary angiographies (images of the heart's blood vessels) of patients with stenosis, or blocked arteries. Specifically, they were asked to estimate the extend and location of the stenosis; the four doctors disagreed on 60 percent of the angiographies. Other examples are provided and implications for clinical practice are discussed. The author summarizes with four general points that should be considered in approaching this challenge. Medicine is not randomly practiced and variability occurs because of the complexities of the problems presented. Most medical practices are effective and improve the patient's quality of life. The complex problems that arise in medicine should not be blamed on the physician; most doctors are sincere and diligent. Finally, there is much room for improvement. The answer is not to remove decision-making powers from physicians, but to improve their ability to make better decisions.

Methods, Therapeutics, Diagnosis

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Broadening the responsibilities of practitioners: the team approach

Article Abstract:

Physicians may take a team approach to making different treatment decisions. The potential risks of a treatment often need to be weighed against the potential benefits. A team approach would involve coordination of a multidisciplinary team to reach a certain set of objectives. This team would be under the guidance of some type of coach such as a medical director. The coach would be responsible for coordinating the efforts of the individual team members. The members of the team would suppress their individual desires and even the emphasis on individual patients, and assist other team members to reach a common goal. This approach may conflict with a physician's perceived right to autonomy, which means managing their patients' care as they see fit.

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Three battles to watch in the 1990s

Article Abstract:

Three factors will affect health care reform in the 1990s. Controlling medical care costs is the most important goal of health care reform. Its importance outweighs that of universal access to and quality of health care. Changes in financing will not solve the problem of increasing health care costs. Costs will continue to climb regardless of the type of financing program implemented. Physicians' treatment decisions will continue to play an important role in the cost of medical care. Overuse of different types of treatment is responsible for a large portion of health care costs. Physicians need to learn to make cost-effective treatment decisions. These types of decisions are complex and are affected by a wide variety of factors.

Economic aspects, Medical care, Cost of, Health care costs, Health care reform

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