Bob,
I agree with your diagnosis, by your treatment is disastrous. It seems to
be a technological fix to a very complex problem. Americans need to
realise that most of the rest of the world has been much more successful
at controlling costs than they have. The reasons are complex, but they
need to be understood. One of the citicisms of US medical training for
Australian Docs is that people are trained to use technology rather than
to think about the problem. Whether this is fair I don't know, but it
seems that many of our modern age failures are due to using technology
without thinking properly about what we are doing.
We need doctors who are trained to be efficient. Who is talking about
that!!!
Gray.
At 04:39 PM 21/1/96 -0500, Bob Luttman wrote:
>I must agree with Gray, much of the trouble in healthcare comes from
>removing decision making from the bedside and the lack of real teamwork
>amongst the care team. Healthcare is so hierarcical and 'divisionalized'
>that learning is disabled. What we need to do is have better learning
>organizations in healthcare starting with the care team and working upward
>and outward through the organization and across disciplines.
>
>I also agree that we need to find a better way to get economic decision
>making into clinical decision making. I have worked on and with
>rudimentary systems for doing as part of a computerized order entry
>system. Clinical epidemiology also has some potential as does outcomes
>measurement. The problem is that outcomes measurement is problematic and
>this makes cost-benefit analysis murky.
>
>We also, like much of industry, do not have good cost accounting systems
>so our economic analysis is often muddled.
> Bob Luttman
-- Gray Southon Consultant in Health Management Research and Analsysis 15 Parthenia St., Caringbah, NSW 2229, Australia Ph/Fax +61 2 524 7822 em gsouthon@ozemail.com.au