nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Saturday, January 29, 2011

Medical Quote Of The Day - 29 Jan 11

This is a long quote.  And it's not a funny one.

I've struggled with a vision of health care reform throughout the three years I've been writing here.  I know the Big Four issues:  Coverage, Access, Cost, Quality.  I know they are inextricably linked such that attention to less than all at once will fail.  I don't want a slogan...maybe later.  I've used the phrase "Patient-Directed Care" to express my frustration with the "patient-centered" approach that's being touted by policy wonks.  I'll keep working on the vision.

But the following, by a practicing physician, published in the New England Journal of Medicine (Sep 10, 2009) captures the perspective that I see for doctors and the patients they serve.
It is a tired and cynical cadre of physicians who will implement health care reforms. Yet few published perspectives include the view from the factory floor. The usual platitudes about changing financial incentives, increasing efficiency, and delivering high-quality care sound naïve to clinicians who deal with the imperfections of human nature and the messy effects of illness on patients. Doctors are already, by training, sophisticated decision-making machines, capable of achieving extreme efficiency through the use of heuristics and experience.

The main problems that clinicians face in achieving efficiency and reducing costs are, first, a perceived need for certainty in diagnosis and treatment — a need driven by secular expectations and malpractice concerns; second, gross inefficiency created by obligatory documentation to satisfy billing requirements that have little value for clinical care; and third, restrictions on the use of clinical judgment that could avoid excessive testing. None of these problems, whose solutions would save money and time, have been incorporated into the national discussion about reform.

One change that would augment the role of clinical judgment would be for the health care system to resist the temptation to require adoption of often-elusive “best practices.” There has been an assumption by analysts that published clinical trials provide a sound guide for therapy, but all reputable studies report odds, hazard ratios, and effect sizes, almost all of which are small or modest. Absolutes are discordant with the realities of sickness and health. There may be guidelines and measurable outcomes for mundane problems, but for the vast majority of daily doctor's visits and hospital decisions, incremental or recursive approaches to diagnosis and treatment are more effective and efficient.
--Allan H. Ropper, MD

This is very Kantian.  Persons are ends in themselves...and unique.  Large-scale social planning in an area like health care  places other priorities in conflict with the interests of persons.
Doc D

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