Leawood, KS—Too often, America's health care system doesn't help people avoid illness and doesn't heal patients who are ill.
In a health care system focused on selling goods and services, the basic elements of healing — relationships and personalized care — can be hard to find.
What has gone wrong in American health care? 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.
"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."
Future commentary topics are:
- The paradoxical payoff of primary care — better whole-person and system outcomes despite apparently poorer quality disease-specific care (July/August 2009);
- The nested hierarchy of health care — how health care can be organized to enable the higher levels that are unintentionally devalued by current approaches (September/October 2009);
- Ways of knowing in health and health care — how understanding development in 4 complementary domains can inform a science and practice of integrated health care (November/December 2009); and
- Cycles of renewal and adaptation — that identify useful strategies for the current unstable position in the health care cycle (January/February 2010).
- Regaining moral authority – a call for action based on understanding the iron triangle created by moral authority as sacrifice and the well-focused use of power directed toward a righteous cause.
Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's Web site, www.annfammed.org.
Journal
The Annals of Family Medicine