Blog | Thursday, May 14, 2009

Fixing the house of medicine from the inside


As promised, the story of how Bob Brook wants doctors to spend less, in addition to eating less. At the SGIM opening session this morning, he called on physicians to improve the quality and lower the cost of their care, before making demands for insurance and payment reform. He suggested that the Journal of General Internal Medicine only publish research that works toward lowering costs (by, for example, testing out a new, less expensive alternative to an accepted treatment). He also recommend that physicians threaten their hospital CEOs with a job action unless they start working to increase the value of care provided at their facilities.

His ideas sounded pretty revolutionary until the keynote lecturer on geriatrics, Albert Siu, MD, made some similar arguments. He also called on general internal medicine to prove its value in caring for chronically ill patients. His point was that PCMH-like models would never be fully supported until primary care proved its value. Although he also said that payment system had to be reformed in order to show the value, so it seemed like a slightly circular argument.

Both lectures included the sort of digs on more procedural specialties that you would never hear at, um, other internal medicine meetings. These SGIM folks are not afraid to say how they think health care spending should be redistributed. But they also placed some of the blame on primary care, for not providing "excellent, affordable, humane care," as Bob Brook put it. Sounds like a challenge.