From: tclark@news.weeg.uiowa.edu (Terry Clark)
Subject: Re: Future of Community-based medicine
Organization: University of Iowa, Iowa City, IA, USA
Distribution: usa
Date: Mon, 28 Dec 1992 03:04:34 GMT

>From: nyeda@cnsvax.uwec.edu (David Nye)

[IN HIS REPLY TO:reply to hrubin@pop.stat.purdue.edu]

>>>The big question of how to cut costs without cutting quality depends on
>>>what you mean by quality.  If we continue to insist that quality means
>>>unlimited access when we want it to all health care resources, then it
>>>can't be done.  If instead we decide that we really just want reasonable
>>care for everyone, we can have it for much less than we currently spend.
- >>(DELETION FOR B.W.)

>>This is a typical totalitarian bureaucratic attitude toward what is
>>reasonable, and it means poor care and little progress in any situation
>>which requires thinking and innovation.  If the rationers decide that
>>only 2% of our national income can be spent on medicine, that is what
>>will happen.

>I'm not saying that I like any of this.  >>(DELETION FOR B.W.)
>I share your concern about the loss of thinkers in medicine. >>(DEL.)
>It could get a lot worse, depending on what
>happens politically.  Add to this the increasing complexity of medicine.

>The only way I can see for doctors of the future to be able to cope with
>all this information is with computers.
-->>(DELETION FOR B.W.)

>I suspect the quality of medicine as practiced by the average
>practitioner would be markedly better under such a system.  perhaps it
>would even be reasonable to have nurses provide all community-based
>primary care.  Most physicians would be involved in research, sorting
>out the information needed to update the expert system and doing basic
>research.

>David Nye
>nyeda@cnsvax.uwec.edu
_______________________

Vastly increasing the computerization of medical care from the nurse at
bedside doing patient care and IR linked data query/entry to the clinician
at bedside checking a differential list with an IR linked pen-pad using 
the latest diagnostic package to the row of humming hard drives and WORMs 
in the medical records department to the consultant checking the labs 
his patient had done 200 miles from his office, computers are the only hope
of delinvering anything resembling quality health care in the future.

But I have to inject my own bias on the issue of community-based primary
care.  I am a Physician Assistant and although I have great respect and love
for many of the nurses I have worked with I don't think thew would be the best 
choice as the "primary" health provider in the suggested system.  I think 
the fault is partly historical and partly a fault of nursing education, but 
the result is that nurses are trained (in large part) NOT make a final clinical
diagnosis and treatment. (For you flamers that is a lament, not a put-down. 
There is an awful lot of wasted talent in medicine).
PAs are trained to make a diagniosis and start a course of therapy in 
conjunction with a physician.  A properly trained and supervised PA can 
handle most community-based primary carc cases with minimal time demands 
on the supervising physician.

With a good telemedicine system a physician can supervise medical care
in several sites and still have time for planning and/or research or 
maybe a little bit of a real life outside the office.  All at a lower cost
than what we pay now.
__________________________________________________________________________
  Terry Clark P.A.-C.                              tclark@weeg.uiowa.edu