scrutiny

[Guest guest]

My first seven years of practice were spent without scrutiny. I did

not work in school clinics nor have students observe my private

practice. I never had to explain my thoughts on my patients in real

time. For the past 3.5 years, it has been the opposite. The vast

majority of what I do is scrutinized by students, colleagues,

superiors, regulators, etc. I do have my own patients, but I never see

them without observers anymore. It would not be possible to function

in an institution without the standards I speak of. One could not

share charts in any meaningful way if nomenclature did not mean the

same thing to all. So when you see liver qi depression as the dx, we

all know what we are talking about. Instead, every time I see an

established clinic patient for the first time, I need to review their

entire chart to get my own sense of the patient due to differing terms

and concepts and standards. I wonder if this also is the source of

some of our disagreements here. that some speak to the needs and style

of a private clinic and others like myself to those of a larger

institution. without standards of care, there is no larger institution

of any significance, IMO. I also think that private clinics giving

high priced elite care is not the wave of the future nor the answer to

our healthcare problems. Whatever model that arises next to supplant

the HMO will still probably be a cost-controlled institutional solution

like a national healthcare system. So I think most of the future

employment will be in this realm, one way or the other. Thus I speak

to this perceived need.

 

There will always be mavericks in private practice. this has also been

the case amongst MD's forever. But for an educational system and for

medicine being delivered to most of the masses from large facilities,

standards are essential. I think CM would not have survived in modern

china without standardization on certain fundamental levels. I don't

think it will survive here without some of the same. However this

should not be construed to constrain one's private practice. If you

make a private transaction between yourself and your patient to give

care, do as you please. But when one takes insurance payments or tax

dollars, one is receiving money from other taxpayers and insurees. I

think most people would prefer that that if their money is being spent,

they can be assured that it is according to some standards. Merely

getting a medical license no longer allows a medical doctor to do as

they please when taxes or insurance covers it. So while I don't

approve of insurers making medical decisions, the old fee for service

did not work, either. Standards should regularly be debated and

revised by impartial but educated committees. I suppose if we could

show that just letting everyone do as they pleased yielded satisfactory

clinical results, then that could be our standard. But lets think

carefully about the message that finding would send. :-)

 

For those who would bemoan their loss of freedom if (or when) this all

comes to pass, fear not. Sometimes the most exciting forms of

creativity arise within certain boundaries as opposed to that which

comes from being completely unfettered. Its very subtle to take

something " standard " and still make it one's own. But then how do we

have great pianists and conductors performing symphonies from scores

written note for note centuries before. And why do we consider the

subtle interpretation of such to be one of the highest arts.

 

 

 

 

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