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More Medical Care From Specialists found to be unhealthy

Discussion in 'Family Medicine' started by MedicineDoc, May 30, 2008.

  1. MedicineDoc

    MedicineDoc 5+ Year Member

    Feb 13, 2008
    worse than good primary care finds Darthmouth 2008 study of 4.732,448 medicare patients at thousands of U.S. hospitals. Study if due to be published in Jama and was in this months consumer report magazine.

    Darthmouth researchers found thatn patients with serious conditions who are treated in regions that provide the most aggressive care with most tests and procedures, see the most specialists don't live longer or enjoy a better quality of life thatn those who recieve more conservative treatment. Patients treated most aggressively are at increased risk of infections and medical erros that come from uncoordinated care. In addition they recieve poorer-quality care , spend more money on co-pays, ad are least satisfied with their health care. The study noted the dangers of over-reliance on specialists. Looks like it's time to reinvest in primary care and get this specialist oriented medical system train off the tracks.
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  3. MOHS_01

    MOHS_01 audemus jura nostra defendere Physician 10+ Year Member

    Oct 2, 2005

    C'mon... everyone familiar with certain specialties knows that a lot of what they do is a racket (IMO cardiology is the worst offender). If the disease mix were heavily skewed to middle age and elderly patients, high inpatient population, etc -- of course the specialists were driving up costs. I really do not believe that a good portion of our "interventions" demonstrably increase QOL or quality life-years, as outcomes based research is in short supply and has only been in vogue for the past 5-10 years or so.

    HOWEVER --

    I can tell you that I can most often manage many chronic conditions (eczema, psoriasis, acne, etc) better and cheaper than the PCP's who refer to me. I choose cheaper medicines, spend more time educating, do not schedule unnecessary follow-ups, and get better results consistently. This is in large part because I do not keep a waiting room full of people, I run on time, practice efficiently with easy to read and understand handouts, have an excellent, well trained staff, and can spend an extra 10-15 minutes when necessary going over things without getting too far behind.

    Also, the vast majority of the new general derm patients that I see are consultations from PCP's who have already tried what they knew to do (which did not work) or they did not know what they were looking at (in which cases I am not always all that certain either).

    Don't cast too wide of a net -- which is the problem with the study cited.
  4. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    Jan 21, 2006
  5. MedicineDoc

    MedicineDoc 5+ Year Member

    Feb 13, 2008
    Actually, it had occurred to me that derm was probably an exception even before I read your post and that cards was probably the worst offender.

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