What ails America's Healthcare system ? Added focus on prevention, healing and personalised care can improve the healthcare system.
We've lost sight of "the wisdom of a generalist approach in the fragmented world of modern healthcare," says Kurt Stange, M.D., PhD, professor of family medicine at Case Western Reserve University School of Medicine and editor of the Annals of Family Medicine, in the first of a seven-part series of commentaries on reforming the U.S. health care system.
Advertisement"Underlying the current health care failings is a critical underappreciated problem: fragmentation — focusing and acting on the parts without adequately appreciating their relation to the evolving whole," Stange writes in "The Problem of Fragmentation and the Need for Integrative Services." "This unbalance, this brokenness, is at the root of the more obvious health care crisis of unsustainable cost increases, poor quality and inequality."
His second commentary, "The Generalist Approach" in the May/June issue of Annals of Family Medicine, provides insight into the role that primary medical care plays in re-integrating health care into a whole and seamless system that addresses patients' needs and helps rein in costs.
Stange's series illustrates the impact that a patchwork health care policy has had on patient access to high quality care, according to Ted Epperly, M.D., president of the American Academy of Family Physicians.
"This series of commentaries both explains the source of problems in our health care system and describes the solutions," said Epperly. "By understanding how the health care system broke down, we can begin to implement reforms that will lead to efficient and high quality care in the future."
Stange's first commentary cites the case of a patient who — suffering from serious fatigue — "went from doctor to doctor" who "looked in depth at the organ in which (s)he was an expert. Each did the latest tests. Each prescribed the latest drugs and devices. And the patient, the person, got worse. ... This man's experience was the opposite of healing."
By focusing on single-disease or single-organ research, medical interventions and procedures, America's health care polices have chipped away the integrative whole-person care that is the foundation of a high quality healthy care system and is the hallmark of primary medical care, Stange says.
In "A Generalist Approach," Stange describes his experience caring for a patient with multiple and serious health issues. That experience illustrates the value of a strong patient-doctor relationship, the importance of coordinating care with subspecialists and other health professionals, and the high quality of care that all patients should expect.
The patient and his wife, Stange writes, "needed the key aspects of primary care — first contact access, a comprehensive approach, coordination and personalization of care. They also needed specialists who applied their technical skills and circumscribed expertise within the context of generalist principles. They needed a health care system that values and is organized by these principles."
By focusing on generalism, these reforms can be achieved, according to Stange's commentaries. "Strong evidence shows that the way to improve health is to base the system on primary care," he explains. "It will require coordinating the efforts of specialists, generalists, public health workers, and the public on what each does best to promote health."
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