OPINIONEmbrace your team: Small efforts can yield big resultsAMA Leader Commentary. By Edward L. Langston, MD, Jan. 7, 2008. A message to all physicians from Edward L. Langston, MD, chair of the AMA Board of Trustees. Change can be difficult. Sometimes change is frightening. Change also can be invigorating and intellectually challenging. But we should not seek change for change's sake only. In health care, change needs a strong dose of evaluation and analysis to avoid extremes that put people and populations at risk. On the other hand, we need to avoid allowing the perfect to be the enemy of the good. It seems to me that change in health care, and more precisely in medical care, is bimodal. By that I mean, there often seem to be two extremes: change occurs abruptly, at least from a medical perspective, or very slowly. For instance, I recall that in early interventional coronary artery care, angioplasty without stenting was the predominant methodology of care. Within two or three years, the ratio of intervention changed from 85% without stenting of the coronary artery versus 15% with, to 95% with stenting versus 5% without. In medical care, that is a rapid reversal within a short time. Technology and technique advancements can be provocative drivers of rapid change. However, analyzing the rendering of medical care in a more global perspective, change can be slow. Many influential leaders and practitioners, for example, have called for a team approach to providing care in certain well-defined circumstances. But there are forces that negatively impact even the opportunity to test, on a broad scale, the utility of this concept. Why? Many reasons can explain the slow uptake, but one operational factor is that our current payment system does not support the team approach to caregiving. Misaligned economic incentives thwart implementation of the model, even where it has demonstrated benefits for patient care and outcomes. Our care model is financed by a "widget system" that creates barriers to care. By necessity, all team members must grapple for the "widget component" of our system to support their efforts. The people and practitioners aren't bad. It is the system is just misaligned. Therefore, the change to team care happens very slowly, even when it is shown to be the best care within those defined circumstances. Scope of practice also can become a major factor in the equation. And the bureaucracy associated with administration and payment -- while crying for lower costs of the needed care and care modalities -- actually penalizes innovative opportunities more often than not. Our challenges as physicians, in attempting to provide the highest quality of care for our patients in the current gestalt of administrative and political barriers, are immense. Physicians and other caregivers all experience these same challenges and frustrations. Do not be faint-hearted. These are the compelling challenges we must bear in order to explore and design new, innovative and efficient caregiving models and techniques that will benefit our patients. Let me encourage you to find new ways within your community -- whether geographic, academic, administrative or practice-oriented -- to embrace the well-educated, well-trained professionals you work with on a daily basis. I am speaking about the nurses, nurse practitioners, physician assistants, pharmacists, physical therapists and other providers of health care services. Small, innovative, multidisciplinary efforts can frequently produce profound health care benefits. Physicians traditionally have worked with nurses, nurse practitioners and physician assistants to achieve exponentially extraordinary results in coordinated and designed systems. A few years ago, pharmacists working with physicians and a municipal system designed a Diabetic Care Program in Asheville, N.C., that immediately saved the city hundreds of thousands of dollars. The one-city program was so successful that the American Pharmacists Assn. Foundation created the "Diabetes Ten City Challenge" that is spreading across the United States. Employers are requesting programs for their workers. You may find more information about the diabetes challenge online (www.diabetestencitychallenge.com). Coordinated outpatient care using a multidisciplinary team can be a successful operational model. These are exciting new changes and challenges! Don't give up! Plow ahead! You can make a difference! Embrace your colleagues in multiple professional disciplines. Think outside the box. Be bold. Innovation and success is awaiting those who dare to embrace change. Dr. Langston , a family physician from Lafayette, Ind., was chair of the AMA Board of Trustees during 2007-08. Learn more about Dr. Langston at the AMA's bio page. Copyright 2008 American Medical Association. All rights reserved.
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