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The sicker we are, the more people it takes to care for us. Rarely can one physician do it alone. Medicine has come too far, the science and technology are too complex, the diseases are too challenging. Yet specialization often leads to fragmentation. A high proportion of Americans describe the medical care system as a "nightmare to navigate". We might long for the kindly family physician in the hopes of simplifying what seems an overwhelmingly complex process. But these simple solutions are as ill-suited to the challenges we face as using the pony express to deliver today's communications.
Major forces affect medicine and will continue to do so for the foreseeable future. We can move across the globe quickly, bringing us in contact with diseases not previously associated with our climates, while terrorism and bioterrorism have become part of our daily lives. Because of improvements in public health, the majority of illnesses with which we now live are chronic, some of them lasting a lifetime. Moreover, as a nation of immigrants, we speak many languages, come from many backgrounds, and carry many expectations. Couple this with our skepticism about government and institutions, our strong sense of independence, and our drive for information and answers. We are a population of demanding citizens with high expectations! And all the while, medical science and related technologies expand like a tidal wave.
Faced with these realities, how can we construct a medical care delivery system that responds to our needs for intimacy and trust, for caring and empathy so vital to our well-being?
First, patients and families must have the skills to help themselves. What the medical care system provides is vital, of course. But if patients don't learn to manage their illnesses, their medicines, and their food and sleep, the best medicines in the world won't help very much.
Second, care must be given by a team of health professionals. The complexity of medical science has moved far beyond the ability of a single doctor to deliver safely and effectively. Physicians are absolutely critical and usually lead the team. However, help from nurses, pharmacists, nutritionists, physical therapists, and social workers -- all working in a closely coordinated team -- are essential to good patient outcomes.
Third, the team must be part of a larger organization where the capacity exists to build the information systems, communications systems, and knowledge management systems required to practice safe, effective, and responsive medicine today and in the future.
Finally, patients and families, teams, and organizations must be closely linked to the many resources available in the community…advocacy groups, educational resources, and public health departments.
These four requirements weren't as important when illnesses were acute and self-limited. But for longlasting illnesses that often require changes in our daily lives, for patients with high expectations and significant needs, they are vital. When these changes are knitted together using powerful tools adapted to the unique requirements of medicine, the results are attractive for patients and professionals alike. Patients cared for this way report higher satisfaction, greater responsiveness, and better ability to deal with the inevitable ups and downs of their illnesses.
A road exists out of the chaos of medical care today, then, marked by important innovations around the country. We must take it upon ourselves to ensure that the care system we require and pay so much for incorporates the lessons and completes the transformation we so urgently require.
David Lawrence, M.D.
Chairman Emeritus, Kaiser Permanente
September 29, 2002
|A Note to the Reader|
|1||Rebecca, Ages Two to Six: The Chaotic Years with Dr. Landers||1|
|2||The Changing Face of Medicine||11|
|3||Adam Landers, M.D.: The Solo Practitioner||37|
|4||Rebecca, Ages Six to Nine: Asthma Care with a Team||51|
|5||Care That Works: Beacons for the Future||67|
|6||Outside the Walls: Some Lessons from Other Industries||101|
|7||Putting It Together||131|
|9||Reflections: Rebecca's Mother Looks Back||163|