The Future Evolution of the Practice of Medicine
The Future Evolution of the Practice of Medicine
During the past few days, I have reviewed several journals and issues of The New York Times. I conclude from my reading that we are going to see the profession of medicine change more in the next few decades than it has changed in the last 20 years.
The scientific journals contain a few reports that suggest that there will be fewer coronary bypass operations and, possibly, fewer angioplasties performed in the future than in the last few years. The reason will undoubtedly be that there will be more effective drug therapy.
In the future, defibrillation and drugs to revert the rhythm will be used far less often for the treatment of atrial fibrillation (AF). This is true because excellent clinical trials have shown that the control of the ventricular rate is as useful as the conversion to normal rhythm. This approach demands that warfarin be used with great care in patients who continue to have atrial fibrillation with a controlled ventricular rate.
The use of a common and relatively cheap diuretics such as hydrochlorothiazide has been shown to be as effective as many of the recently developed antihypertensive drugs. The latter will be used to control blood pressure in non-emergency patients who do not respond to the cheaper drug.
The excellent doctors in New Jersey deserve much credit. They have highlighted the total unfairness of the high cost of malpractice insurance. Many doctors are paying several hundred dollars each day for malpractice insurance. This is more than Medicare or HMOs can pay doctors for their service. It is not the insurance company's fault. It cannot afford to pay the exorbitant amounts of money awarded by the jury and judge to patients who claim malpractice and the associated legal fees. Therefore, to remain financially solvent, the insurance company discontinues its medical malpractice division.
This domino effect uncovers the real problem. No one questions that patients should have the right to sue. At the same time, it must be realized that medicine is commonly complex and that perfectly implemented treatment does not always produce a cure.
What is happening in New Jersey is also happening elsewhere. Surely, events such as those that occurred in New Jersey will lead to some type of reform that protects patients, but does not force doctors to quit their practice.
A host of other changes are occurring, many of which will encourage an improved doctor-patient relationship as simpler and equally effective therapy is used for the management of many conditions.
During the past few days, I have reviewed several journals and issues of The New York Times. I conclude from my reading that we are going to see the profession of medicine change more in the next few decades than it has changed in the last 20 years.
The scientific journals contain a few reports that suggest that there will be fewer coronary bypass operations and, possibly, fewer angioplasties performed in the future than in the last few years. The reason will undoubtedly be that there will be more effective drug therapy.
In the future, defibrillation and drugs to revert the rhythm will be used far less often for the treatment of atrial fibrillation (AF). This is true because excellent clinical trials have shown that the control of the ventricular rate is as useful as the conversion to normal rhythm. This approach demands that warfarin be used with great care in patients who continue to have atrial fibrillation with a controlled ventricular rate.
The use of a common and relatively cheap diuretics such as hydrochlorothiazide has been shown to be as effective as many of the recently developed antihypertensive drugs. The latter will be used to control blood pressure in non-emergency patients who do not respond to the cheaper drug.
The excellent doctors in New Jersey deserve much credit. They have highlighted the total unfairness of the high cost of malpractice insurance. Many doctors are paying several hundred dollars each day for malpractice insurance. This is more than Medicare or HMOs can pay doctors for their service. It is not the insurance company's fault. It cannot afford to pay the exorbitant amounts of money awarded by the jury and judge to patients who claim malpractice and the associated legal fees. Therefore, to remain financially solvent, the insurance company discontinues its medical malpractice division.
This domino effect uncovers the real problem. No one questions that patients should have the right to sue. At the same time, it must be realized that medicine is commonly complex and that perfectly implemented treatment does not always produce a cure.
What is happening in New Jersey is also happening elsewhere. Surely, events such as those that occurred in New Jersey will lead to some type of reform that protects patients, but does not force doctors to quit their practice.
A host of other changes are occurring, many of which will encourage an improved doctor-patient relationship as simpler and equally effective therapy is used for the management of many conditions.
