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I read with great fascination the proposed changes in the above
article. At a time when the British government have made changes towards
an American model of healthcare, it seems that the American model is
looking to change towards the British system.
No doubt the former was made in the hope of greater efficiency. The
later for its all inclusive nature, thereby addressing the problem of
millions of people without adequate health-care in the US.
Both systems have evolved and have been tested in the real world
setting over the last 60 years, and it would seem to me that the vision
and fore-sight of the founder of the National Health System, Aneurin
Bevan, have rung true.
He had said “Not even the apparently enlightened principle of the
greatest good for the greatest number can excuse indifference to
individual suffering..." in his book, "In Place of Fear", Quartet Books;
1952.ISBN:0-7043-0122-9.
In the same book, he detailed the challenges and solutions in
implementing what was then unheard of before, a state-funded healthcare
for all British people.
Mention must also be made of the late author, Alvan R. Feinstein, who
was the Professor of Medicine and Epidemiology at Yale University, in his
article:
"Scholars, Investigators, and Entrepreneurs: The Metamorphosis of
American Medicine".
In it, he describes in detail, the history and the
evolution of the problems faced not just by the American physicians, but
also of those faced in the managed care health system and in research as
well. In particular, he laments the lost of the ethos of "caritas" and of
the traditions of a caring personal physician, replaced by the demands of
financial "efficiency" and the uniformity in practise, as required by
guideline or protocol-driven care.
He also offered probable solutions, in a way that
only someone who has lived through both worlds of the American health
system can, grounded in the best interests of both patients and
physicians.
There is much to learn from both of these works on both sides of the
Atlantic, in our quest for a better future for ourselves and our patients.
Hopefully, the baby will not be thrown out with the bath water as the
NHS focuses more on Private Finance Initiatives, Payment by Results,
target-driven patient care, target-driven training and the transition to
more protocol driven care by "practitioners".
The Americans have gone through all the above already in the past
half a century. We don't and we shouldn't have to experience all the
associated "pitfalls" first hand in the UK.
I leave you with the final words of Dr Feinstein from the above
article:
"Neither the medical academy nor the NIH are likely to make the
drastic changes needed. The new goals, therefore, probably will have to be
conceived and formulated by practicing clinicians, working through their
professional
organizations and hoping that the organizations will develop enlightened,
courageous leadership.
If the aims are merely to resurrect the golden age, to retain the
status quo, or to recover what existed before the managed-care takeover,
the problems will remain unsolved, and the system will remain unstable. If
the
leaders have adequate vision, however, they can develop policies aimed at
four main goals:
1. To promote not just the customary type of basic science used for
explicatory research, but particularly the new type needed for clinical
evaluations;
2. To reduce costs by eliminating unnecessary or unconfirmed
procedures;
3. To provide universal health-care coverage; and
4. To restore a Samaritan ethos to medical care."
Thank you.
Competing interests:
None declared
Competing interests:
No competing interests
16 December 2007
Samuel Chew
SpR Geriatric Medicine
City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK
Two ships passing in the night...
I read with great fascination the proposed changes in the above
article. At a time when the British government have made changes towards
an American model of healthcare, it seems that the American model is
looking to change towards the British system.
No doubt the former was made in the hope of greater efficiency. The
later for its all inclusive nature, thereby addressing the problem of
millions of people without adequate health-care in the US.
Both systems have evolved and have been tested in the real world
setting over the last 60 years, and it would seem to me that the vision
and fore-sight of the founder of the National Health System, Aneurin
Bevan, have rung true.
He had said “Not even the apparently enlightened principle of the
greatest good for the greatest number can excuse indifference to
individual suffering..." in his book, "In Place of Fear", Quartet Books;
1952.ISBN:0-7043-0122-9.
In the same book, he detailed the challenges and solutions in
implementing what was then unheard of before, a state-funded healthcare
for all British people.
Mention must also be made of the late author, Alvan R. Feinstein, who
was the Professor of Medicine and Epidemiology at Yale University, in his
article:
"Scholars, Investigators, and Entrepreneurs: The Metamorphosis of
American Medicine".
In it, he describes in detail, the history and the
evolution of the problems faced not just by the American physicians, but
also of those faced in the managed care health system and in research as
well. In particular, he laments the lost of the ethos of "caritas" and of
the traditions of a caring personal physician, replaced by the demands of
financial "efficiency" and the uniformity in practise, as required by
guideline or protocol-driven care.
He also offered probable solutions, in a way that
only someone who has lived through both worlds of the American health
system can, grounded in the best interests of both patients and
physicians.
This article can be found at:
"http://muse.jhu.edu/login?
uri=/journals/perspectives_in_biology_and_medicine/v046/46.2feinstein.html"
There is much to learn from both of these works on both sides of the
Atlantic, in our quest for a better future for ourselves and our patients.
Hopefully, the baby will not be thrown out with the bath water as the
NHS focuses more on Private Finance Initiatives, Payment by Results,
target-driven patient care, target-driven training and the transition to
more protocol driven care by "practitioners".
The Americans have gone through all the above already in the past
half a century. We don't and we shouldn't have to experience all the
associated "pitfalls" first hand in the UK.
I leave you with the final words of Dr Feinstein from the above
article:
"Neither the medical academy nor the NIH are likely to make the
drastic changes needed. The new goals, therefore, probably will have to be
conceived and formulated by practicing clinicians, working through their
professional
organizations and hoping that the organizations will develop enlightened,
courageous leadership.
If the aims are merely to resurrect the golden age, to retain the
status quo, or to recover what existed before the managed-care takeover,
the problems will remain unsolved, and the system will remain unstable. If
the
leaders have adequate vision, however, they can develop policies aimed at
four main goals:
1. To promote not just the customary type of basic science used for
explicatory research, but particularly the new type needed for clinical
evaluations;
2. To reduce costs by eliminating unnecessary or unconfirmed
procedures;
3. To provide universal health-care coverage; and
4. To restore a Samaritan ethos to medical care."
Thank you.
Competing interests:
None declared
Competing interests: No competing interests