Pyrrhic Victory

During recent lobbying for his health care reform platform, US President Obama praised organizations such as Intermountain Health for being role models in providing high-quality care, without skyrocketing costs. Obama echoed comments made by a senior Intermountain executive: “Much of the rest of the country tends to focus on the volumes of health care services they provide, because that's what the system rewards, rather than the care that's necessary to help the patient.”

Bingo.

Have you had the chance to read “On the folly of rewarding A, while hoping for B” yet? According to this classic essay, we should expect exactly the system we have, that is, pay me fee-for-service and I’ll give you lots of service. And don’t call me greedy; we’re all responsible (via elected politicians) for supporting this dysfunctional system of rewards.

Awkward

The problem with first-year medical students is that they haven’t yet learned which questions not to ask.

Two weeks ago, I had a student spending the afternoon with me at my office. We met a patient and his wife, and talked with them about the results of a CT scan he had done earlier in the day. After the visit, the student asked me "Why did he have to come to your office today?" Her concern was that the man had difficulty walking and had recently moved into a care home an hour away from Saskatoon. It was a significant effort for them to travel, both to get to Saskatoon and then within the city.

My staff is diligent about scheduling CT scans (and other tests) on the same day as an office visit, so I can review the results with the patient. I pointed out to my student that this saves people an extra trip into town.

Then she got really impudent.