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November 19, 2010
In a previous post about how health reform will change your doctor's visits, I mentioned that you're likely to see your future primary care delivered by a "team" of health professionals rather than your doctor. You might be surprised to hear that "team" is a relatively new concept in family medicine. I once had a colleague who told me, only half in jest, "My definition of good teamwork is that when I tell my office nurse to do something, he or she does it." Personally, I've always favored nurses or medical assistants who excelled at anticipating my needs: those who would prepare a suture tray when a patient showed up with a laceration, for example, or open a urine specimen container for a patient complaining of flank pain and chills.
In contrast, a high-functioning health team doesn't require doctors to issue orders all the time—or expect nurses to read their boss's mind. These medical assistants can read charts and test results to determine if a patient, say, needs a referral or isn't up to date on an immunization. Medical degrees aren't required for these things, according to a 2004 commentary on health care teams that was published in the Journal of the American Medical Association. If doctors can hand off some of their responsibilities to others on their medical team, this would solve two tough problems in today's medical system. First of all, we're facing a primary care physician shortage that's only going to get worse when nearly all Americans get health insurance in 2014. Massachusetts and California, which already have universal health care systems, have seen severe shortages in pediatricians, family physicians and obstetrician-gynecologists. Medical teams could allow doctors to expand their practices, seeing more patients each day. They could also solve the time-crunch problem where appointment slots in some offices have been reduced to 12 minutes per patient. Nurse practitioners and physician assistants can set aside far more time to discuss lifestyle changes and the side effects of various medications than doctors rushing from room to room.
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November 4, 2010
At a recent conference, Harvard surgeon and best-selling author Atul Gawande told the audience of health professionals and policy makers that he always assigns his medical students a book about baseball called Moneyball: The Art of Winning an Unfair Game. It's the story of how the 2002 Oakland Athletics, which had one of the lowest payrolls in professional baseball, were able to consistently out-compete better financed teams due to their general manager's unrivaled ability to evaluate and appropriately value players. Oakland took advantage of the tendency of other teams to overvalue players based on word-of-mouth assessments of talent or commonly measured statistics—such as batting averages and number of stolen bases—that had little relationship to winning games.