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Health-care reform and the lost art of healing

DOCTOR
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Value-based care is the new wave of health-care reform.

In 1996, the renowned Dr. Bernard Lown—emeritus professor of cardiology at Harvard and founder of the Lown Cardiovascular Group, among other distinctions—published The Lost Art of Healing. The book may be more than 20 years old, but its message is as timely as ever, and arguably more urgent today then in 1996. The New York Times put the spotlight on Dr. Lown’s message when it recently ran an Op-Ed by an intern at Brigham and Women’s Hospital in Boston who encountered the venerable physician when Dr. Lown was in that hospital being treated for pneumonia.

In The Lost Art of Healing, Dr. Lown charged that “doctors no longer minister to a distinctive person but concern themselves with fragmented, malfunctioning” parts of the body. The doctor-patient relationship, the author lamented then, and still laments today, has become impersonal, mechanical, remote and cold. In The Lost Art of Healing he called for the revival of the “3,000-year tradition, which bonded doctor and patient in a special affinity of trust.”

As resident physician Rich Joseph wrote in his column, Dr. Lown has called for “a return to the fundamentals of doctoring—listening to know the patient behind the symptoms; carefully touching the patient during the physical exam to communicate caring; using words that affirm the patient’s vitality; and attending to the stresses and situations of his life circumstances.”

At 96, Dr. Lown made it clear that he was not pleased with the state of affairs he had warned about all those years ago, and which today he describes as the “industrialization of the medical profession.”

The Times piece is worth quoting at length because it so pointedly and accurately describes the state of contemporary health-care in the US, both in its for-profit and publicly-funded forms. The case is worse for the latter, with traditional Medicaid being particularly prone to impersonal medical care and an emphasis on transactional treatment in the form of tests and perfunctory office visits; a formula that is prone to waste and fraud, and that provides very little if any opportunity for the establishment of a bond between patient and doctor.

Enter the Delivery System Reform Incentive Payment (DSRIP) Program, a pioneering approach to Medicaid ushered in by the New York State Department of Health that has just begun the fourth year of its five-year mandate. Its goal: the reduction by 25 percent of avoidable hospital use at the end of five years, which would amount to a savings of more than $12B for New York State taxpayers.

These are impressive facts and figures; important as they are for the bottom line, they are secondary. At the heart of DSRIP is superior, holistic care for Medicaid patients who are treated as human persons, not as cost centers or bundles of various medical ailments—care precisely of the kind Dr. Lown insists has gone missing.

Value-based care is the new wave of health-care reform; it will deliver superior care, thanks, in part, to a strong emphasis on preventive care. This, in turn, translates into reduced health-care costs by keeping people healthier and out of hospitals, etc. It would make a lot of sense for policy-makers to begin paying closer attention to value-based care—and to consider funding the efforts of Independent Practice Associations. This would enable the independent doctor as entrepreneur to succeed under the VBP regime by providing truly personalized health care, whose quality hinges on that “affinity of trust” between doctor and patient. This would be a much-needed complement to the massive funding of inevitably more impersonal hospital-based systems that currently dominate the publicly-funded health-care arena.

Mario J. Paredes is the CEO of SOMOS, a network of doctors and health personnel, located in New York and Puerto Rico. 

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