Our medical care system does not deal well with chronic illnesses; it really concentrates on and is best at treating acute illnesses or trauma – as it has done for the last century and more. But more and more illnesses today are chronic and complex, lasting a patient’s lifetime and bearing very high costs. And most are preventable since they are due to adverse lifestyles or behaviors like overeating, lack of exercise, stress and tobacco.
Chronic illnesses account for over 70% of all health care costs today – diseases like diabetes, heart failure, cancer, chronic lung disease and others. The best way to care for these chronic illnesses is with a good primary care physician and a multidisciplinary team approach. This is not the typical way our medical care delivery system is organized. We tend to have a system that relies on a single provider treating an illness – the internist gives an antibiotic for pneumonia and the surgeon cuts out the diseased gall bladder. But patients with chronic illnesses often need multiple providers. For example, the diabetic may need, in addition to a primary care physician, an endocrinologist, an exercise physiologist, a nutritionist, an ophthalmologist, a vascular surgeon, a nephrologist, etc. But this team needs a coordinator or quarterback and this is preferably the primary care physician. Good care coordination can direct the patient to the care he or she needs while reducing the number of unnecessary specialist visits, procedures, tests and imaging — with the result that the quality of care goes up and the cost of care goes down substantially.
The multi-disciplinary team care approach is new for most providers and the way our healthcare system is organized, it is difficult to arrange. Worse, the primary care physician is always short of time – time to listen, time to think, time to give really intense preventive care and time to coordinate the care of those with chronic illnesses. Time is the missing ingredient to optimum care.
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This lack of time results in less than adequate care, less than adequate prevention and skyrocketing costs. Simply providing the PCP with sufficient time (i.e., the need to see fewer patients per day in return for the same total income) would vastly improve care and reduce overall costs.
Chronic illnesses not only last a lifetime and are difficult of manage but are also the diseases that are driving the high cost of care. These costs can be brought down and can be brought down quite substantially through a better approach to patient care, one that gives major attention to disease prevention and intensively coordinates the multidisciplinary team approach to care for those with chronic illnesses. But for this to happen, PCPs need more time with these patients.
Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center. He is the author of The Future of Health Care Delivery- Why It Must Change and How It Will Affect You from which this post is partially adapted.
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