When the Patient Can't Afford the Care

During my surgical training, I took care of a patient who could barely afford the dressing supplies I had prescribed for him. While caring for him, I realized that in the busy day-to-day pursuit of becoming a good doctor, I had telescoped in on the clinical details, neglecting my once-cherished ideal to embrace the social and economic aspects of health care. 

Last fall the journal Academic Medicine reported that the vast majority of students felt they had received adequate clinical training during their four years of schooling. But fewer than half felt they had had adequate exposure to health care systems and practice, an area of study that extends to subjects such as medical economics, managed care, practice management and medical record keeping.

When the researchers compared the five-year results from two different medical schools, they found that students who had attended the school with more of these types of courses were significantly more satisfied with their education than students from the school with fewer. Moreover, regardless of how much of their school’s curriculum was devoted to these nonclinical topics, students remained equally satisfied with their clinical preparation. 

In this week’s “Doctor and Patient” column, I interview these researchers who believe that it is possible to learn about the economic and social aspects of health care while immersed in clinical learning and that it is impossible to become a good clinician without doing so. Do you think learning about the economic and social aspects of health care is possible within the constraints of the current medical school curriculum? And is it important to becoming a good doctor? Please leave your comments below or on Tara Parker-Pope's "Well" blog.

 

Comments

[Katherine katen Moore]

I really like reading your column in the Times. I wish I could work with more MDs who think about things -- like you do.

Katherine Katen Moore, MSN, ANP-C, AOCN

[Nataliehodge]

Absolutely Pauline,

It is nice to see some data about medical student and resident education incorporating practice management and social implications of medicine. I would add to that technology, innovation, emerging health 2.0 industry and participatory medicine to the pile here. In primary care it is of utmost importance that medical students and residents emerging from training understand the trends in third party reimbursements (decreasing), the trends in fixed costs of practice ( rising) and encourage use of emerging technologies to serve patients better. This includes emerging devices (ipad) emerging 3G/4G wireless, web SAAS platforms ( as opposed to traditional HIT licensing models) as well as ecommerce strategies ( as opposed to outdated billing software platforms)

These young MD's in primary care have the potential to transform global healthcare delivery as we know it, using tech, content, community, social media tools.

Primary Care Physicians have lost a lot of ground to emerging delivery models as Take Care Health and Minute Clinic. And we will continue to lose ground to " the internet" if we don't get in the game.

Natalie Hodge MD FAAP
Co-Founder Personal Medicine
http://personalmedicine.posterous.com/
www.personalmedicineinternational.com

[Stephanie Jewett, RN, MBA]

Excellent post and very good site! Stephanie

[Nayana Somaratna]

As a medical student, I received an excellent training in clinical medicine but little or no exposure to the social and economic side of things.

I only started realizing how important these aspects of health care were once I started my career as a doctor.

Even though most investigations and treatments might not cost much when taken individually, all of these add up to a large bill over time.

I do think that it is possible to stress on the important of these aspects of healthcare during medical college.

However, the maturity to understand and apply this knowledge is only likely to appear after they have become doctors.

Nayana Somaratna, MBBS, BIT
http://blog.medicaljoyworks.com

[R. Winters]

Your article, "Nurses' Role in the Future of Health Care", is a good one that deserves attention, but one statement in it is not correct: "Nurses currently form the largest sector of health care providers...". In fact, with 6 million professionals, allied health providers outnumber nurses 2 to 1." Their future role in health care must also continue to expand.

[estetik]

I like reading this page. As a medical doctor I understand all your feelings about poor patients.