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The Physician's Place in the ACO



Development of accountable care organizations may be critical to holding down costs and improving quality. But how will doctors' roles change?



2 comments on "The Physician's Place in the ACO"
John Barbuto, MD (3/11/2011 at 1:00 PM)

You make a statement which is critically flawed. You say patients "are trying to get well". That is certainly true to a large extent. But, it has subtle, critical flaws. First, patients who seek health care are certainly trying to get health care, but they are routinely trying to get the health care they "think" will make them well. They are trying to meet their belief systems - which may or may not be consonant either with optimal care or with achieving health. For example, there is a huge industry of "health care" which is purchased via health food stores or other "complementary and alternative" sources. The vast majority of these services are provided with no rigorous science behind them at all - only claims and anecdote (and maybe some inferential low order studies). In these realms the hypothesis of "evidence-based medicine" is a joke; yet, the services are consumed to the tune of many billions of dollars a year. And, this example only represents a concept which has much greater ramification even than this industry. In addition, a small but critical portion of patients come to the doctor to obtain services which support some secondary agenda - an agenda which may not be served by becoming well. So, for example, auto or industrial accident blame games, unwarranted disability pursuits, escape from responsibility, social control over others, and other "hidden agendas" lead to service which is rendered not to become well but rather to serve the hidden social agenda. This also is big business in some arenas. So, while it is true that most patients seek to become well, the most accurate statement is that patients seek health care to receive health care services - whatever agenda may be underlying the pursuit. We like the hypothesis that medicine proceeds best based on evidence-based science. But, the actual evidence is that this hypothesis is flawed in some important ways.
Gregg Masters (11/16/2010 at 2:08 PM)

Nice piece! We really need to keep the focus on the provider education perspective; via a lens of institutional memory, lest we recreate the same mistakes of the past. The scope and range of concerns, including the many competing voices for visibility in this space require attention on key narrative curation, and vetting of the many threads in this unfolding story!