American College of Physicians: Internal Medicine — Doctors for Adults ®

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Friday, August 8, 2014

What's great about U.S. health care?

Anyone from outer space reading the news and watching TV would think that the U.S. has some of the worst health care possible. The negativity appears to be pervasive. Controversy over this, outrage over that. Whether it’s inadequate health outcomes, policy debate, or scandals with patient care, the stories and discussion abound. As someone who grew up and went to medical school overseas and then came to the U.S. for medical residency (along with many others), I find some of this baffling.

Let’s start first by agreeing that, yes, the U.S. health care system has big problems. But then, what health care system doesn’t? I’ve seen first-hand the systems in many countries, including the United Kingdom, Australia, and India, and have yet to find one which is perfect. The U.S. health care system compared with other Western nations probably struggles most with inequity and access. Yet at the same time, U.S. hospitals are undoubtedly some of the most advanced in the world. To balance out all the negative that we hear about, I’d like to point out 5 things that make the U.S. health care—and particularly hospitals—great:

1. Rapid access to what you need
When you are in hospital, whatever you need is easily accessible and you are more likely to get a rapid diagnosis than in most other countries. Whether it’s a scan, specialist opinion, or other invasive treatment, U.S. hospitals will get what you need quickly, often within hours.

2. Patient choice and empowerment
Being patient-centered is more than just a buzzword. It’s the reality all across the nations’ hospitals. Patients are empowered to ask questions, seek second opinions, and if needed, complain, to an entity that will listen to them. This is not the case in many nationalized systems that adopt a more paternalistic approach. Along the same lines, we take it as a given that we have choice as to what hospital we go to and which doctor sees us. When treatment is given, medico-legally patients’ rights take front and center. It may have gone too far the other way, leading to defensive medicine and crazy high insurance premiums for physicians, but remember that Third World countries (representing the majority of the world) have hardly any checks and balances on the actions of doctors who can literally practice unaccountably. It’s obvious which extreme is better for patients.

3. Comfortable environment
Hospitals are more comfortable and accommodating than almost anywhere else in the world. It’s not uncommon in other developed countries to have a dozen or so patients in a single large room. Some industrialized countries still struggle with separating male and female patients into different rooms, a basic matter of dignity denied. While we still want to make hospitals even better, for instance with less noise and more palatable food. Let’s not forget how far ahead we are too.

4. Statistics
A lot of the endemic chronic diseases in society are ironically a consequence of the wealth of the country, such as overeating and lack of exercise (everyone has a car, so why walk?). A case perhaps of your biggest strength also being your biggest weakness. Casting aside the bad statistics, which can certainly improve, did you know that the U.S. has some of the best statistics in the world for surviving a heart attack, stroke, and cancer? According to one study in the Lancet from 2007, American women have a 63% chance of surviving at least 5 years after a cancer diagnosis compared to 56% for European women. For American men, it’s 66% compared to 47% for European men.

5. Research, innovation, and entrepreneurship
American university-affiliated hospitals lead the world in research and development. From life-saving medications developed by U.S. companies to procedures such as heart stents, many of the world’s newest drugs and technologies are developed right here, with millions benefitting from them. Talking a little about physician entrepreneurship, many people see this as a double-edged sword. If it leads to inappropriate prescribing, it is of course a bad thing. But when it leads to innovation and cutting edge new technologies and treatments, what’s wrong with physician entrepreneurs? This drive and motivation is lacking in many Western countries with more centralized systems.

Taking things for granted is part of human nature. Does the U.S. health care have major problems to fix? Absolutely. The cost of the system is unsustainable in the long term and we have to improve access for everyone. But we start from a good position. Looking at crude health care statistics such as countries’ ranking can sometimes be misleading and skew certain positive and negatives. I’d like to leave you with 1 thought that I would challenge anyone who has been to hospitals in other parts of the world to ponder over, and particularly relevant when one of the biggest complaints about U.S. health care is about inequality: A homeless American entering the doors of a hospital with an acute medical issue, be it sepsis, a myocardial infarction, or a stroke, will get better care than a rich person almost anywhere else in the world. Anyone disagree?

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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