2001 A Health Care Odyssey
Change is the watchword of our times. But as the year 2000 approaches, the
rapidity with which change is happening in health care is often perplexing even
to those leading the way.
"We should not be too surprised if the health care world is in some disarray ... We are experiencing our part of a general social condition," comments Roger Bulger, MD, a nationally renowned scholar and leader in health professions education, who spoke before the UMDNJ Task Force on Education/Curriculum.
Where is this leading? Bulger addressed this question, and others. "I would remind people that historian Daniel Boorstein calls America the 'Republic of Technology,' a republic which offers all of us hope through technological inventiveness and competence," says Bulger, who is President of the Association of Academic Health Centers.
But he continues with a line from a poem written by Howard Nemerov, a US Poet Laureate: "Praise without end for the go-ahead zeal, of whoever it was that invented the wheel. But nary a word for the poor soul's sake, who thought ahead and invented the brake."
He points out that "braking" is a major issue in health care now: What will be rationed and who will do the rationing? And how will this affect patient autonomy and what Bulger calls "our collective experience of hope and mercy?"
The "easy cost-cutting phase is almost over in health care," he says.
The scholar outlined emerging trends: health care's broadening scope to include prevention, health promotion and chronic care; an increasing emphasis on out-of-hospital care, preventive home services and telecommunications; the creation of health care teams to maximize value for dollars spent; the electronic medical record which allows a more patient-friendly and patient-centered approach; and an increasing emphasis on quality and value, leading to more stringent assessments of new technologies.
The academic health center, he says, will concentrate on: producing new science, further developing technology transfer, educating health professionals, evaluating new models of care, and instructing the public on policy issues.
How will changes in health care impact on medical education? Students whose primary responsibility has been to absorb massive amounts of information "should begin to understand more about healing, about placebos, about suffering, about death, about the meaning to patients and the public of the entire health care enterprise," Bulger says.
He sees the health sciences university leading the way to a delivery system that's "more integrated, more patient-friendly, more patient-centered, more often evaluated by patient-outcome studies, more often carried out by an array of health care professionals who are in active communication with one another..."
Bulger anticipates a future that will bring much experimentation and evaluation of new models of care, and asks: "Will there be primary elder-care teams made up of nurse practitioners, pharmacists, optometrists and dentists using physicians as occasional consultants? Will there be specialized urban health teams including pediatricians and psychiatrists? Will physician assistants and advanced practice nurses be at the forefront of a regional rural health care team? Will major health care teams continue to develop around specific diseases such as cancer, heart disease, stroke, AIDS and the autoimmune diseases?"
The answers as well as more questions will challenge all of us well into the twenty-first century.