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Healthy Populations

Our hospitals today are concerned that "health care" means fixing health problems that people have.  After all, that's how hospitals have traditionally been paid. Replace a knee joint.  Get paid for fixing the joint.   The more hospitals did, the more they got paid.  

That is changing with reimbursements from Medicaid and Medicare based on, for example, whether a patient stays out of the hospital within 30 days of discharge. Medicaid and Medicare reimbursements can accout for half or more of all hospital revenues.  

Diagnostic Error

Whenever I go to my primary care physician with a complaint, I want the physician to do something to help resolve the complaint. The physician may say that in time the problem will go away. It is nothing to worry about. Or the physician may ask me to do more exercise and eat more nutritious meals. The physician can also write a prescription and ask me to come back after I’ve taken all the pills - if I don’t feel any better. I may be asked to do a test involving a blood or urine sample. I might be given a referral to another physician.

All the while, the physician is trying to select among possible diagnoses, in order to label my complaint. There may be one diagnosis or multiple diagnoses. This is not always an easy task for the physician.

I can also go onto the web and try to diagnosis myself on WebMD’s Symptom Checker. I might go to the drug store or health foods store or go online to see if something is available that help resolve my complaint. I can also ask my friends if they have had a similar complaint. The physician is trained in diagnosis and I’m not. So while I may look online or talk with my friends, I’m going to rely on my physician to help me.

Now, I’ve heard about diagnostic errors, so I want to make sure that my physician and the physician to whom I am referred gets all of my basic information right and that both physicians are communicating with one another about their conclusions. One version of a diagnostic error is whether a diagnosis is delayed. Or the diagnosis may be wrong.

What can patients and physicians do to assure that a diagnosis is made as quickly as possible and that the diagnosis is correct? Click here to let me know your ideas.

Hospital's Role in the Community

The first hospital in America was Pennsylvania Hospital, founded in 1751 by Benjamin Franklin and Dr Thomas Bond in Philadelphia. The hospital was for the poor and the insane. Well to do people did not go to a hospital. The doctor came to them. Pennsylvania Hospital still exists as a Penn Medicine facility.

While there is a question as to what and where the first hospital outside the US was created, some of the earliest hospitals were run by religious organizations, including the Roman Catholic Church. Like the more modern Pennsylvania Hospital, these hospitals cared for the poor and were more like a hospice than anything else. Hospitals were places where poor people could die in relative comfort.

Today's hospitals are places where people who have money or insurance can go and be cared for. People who do not have money, by an Act of Congress in 1984, called the Emergency Medical Treatment and Active Labor Act (EMTALA), can go to the Emergency Room and be stabilized. The role of the hospital has been reversed from Ben Franklin's time.

Now, under the Patient Protection and Affordable Care Act (PPACA) of 2010, nearly all people, rich or poor, will be able to get insurance and care at any hospital. The role of the hospital will be not only to care for the sick, but to work on preventive care and assurance of quality outcomes. Physician extenders, nurse practitioners and physician assistants, will be more important than ever before since the demand for primary care will exceed the availability of internal medicine and family practice physicians.

Preventive care, such as providing prenatal care for all women who become pregnant, will be paramount in health care. Preventive care will include reducing obesity in children and adults, since obesity is related to diabetes, hypertension, high blood pressure, heart disease, joint problems, and other chronic medical conditions.

The future of healthcare will have less reliance on medication and surgery and more reliance of exercise, nutrition, and stress management. Many of the drugs we use today, many surgical procedures, and treatments, such as chemotherapy and radiation for cancer, will be looked upon just as we look upon the very earliest medical treatments and procedures. The community, including schools, churches, banks, restaurants, and other services, will be much more involved than they are now.