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Lister, and Koch. Science-based medicine was quickly enshrined through state licensing laws, and
it maintained its power for almost one hundred years.
A backlash against science and the cultural diversification of the American population have
recently laid the foundations for diverse approaches to health care-including many which are not
science-based. The future will be remarkably eclectic in comparison to the past. accepting clinical
practices that would never pass the tests of the scientific model. Alternative medicines have
joined the pantheon of practice, and those of us who still prefer a scientific approach (the author
included) will have to get used to the competition. The new health care system will offer lots of
choices that were underground only a few years ago. Caveat emptor.
LEADERSHIP
Given the legal authority of scientific medicine in 20th century health care. medical doctors
became the undisputed captains of the ship. Deciding what was wrong with a patient and what to
do about it was under the control of scientifically trained physicians. However, the creation of
Medicare and Medicaid (1965) and the Viet Nam War created widespread fears of a doctor
shortage. Academic medical centers responded by training a new class of caregivers like
paramedics, nurse practitioners, and other so-called mid-level practitioners.
These nonphysician practitioners quickly demonstrated their high levels of clinical competence,
and most states now allow them to practice independently of physicians. In other words, they are
no longer junior officers on a doctor's ship. They will give us a choice of ships for our health care
journeys. The new world of health care-one that will flourish regardless of conventional notions
of health reform-will find many patients going directly to certified nurse midwives for normal
pregnancies. to clinical pharmacologists for adjustment of their drug regimens. or to massage
therapists for stress management. In other words, health care will now be led in many different
directions.
CORE VALUE
Healing touch is arguably the historic cornerstone of health care, witness the fact that health plans
won't pay unless a practitioner delivers the care in person (with the exceptions of radiology and
pathology). However, technological advances over the past decade have created the possibility
that good health care can be delivered without the caregiver and the patient being in the same
place at the same time. Telemedicine can permit a surgeon to operate on a patient hundreds of
miles away using a new technology called telepresence surgery, or it can allow a patient to be
tested for diabetes with a home blood monitor that sends the results to a qualified clinician who
will review the record at a later time and consult with the patient by e-mail.
The exploding realm of e-health even gives us the option of filling prescriptions over the Internet
and controlling our own medical records in a secure Web site. Health care at the beginning of the
21st century is being increasingly liberated from the long-standing barriers of time and place. It
allows patients and their providers to interact without being in the same room at the same time.
For a growing number of patients, the core value will become communications because being
listened to will be more important than being touched.
KNOWLEDGE BASE
In the 20th century, the knowledge base was embedded in textbooks and journals that could only
be accessed and understood by someone who had graduated from medical school, and the patient
had to go to the doctor for health care because professionals controlled access to relevant
information. In the 21" century. the Internet and the World Wide Web open the vaults of medical
knowledge to anyone with a computer and a telephone line. In addition, today's technologies
allow the creation of a multimedia-rich medical record at a fraction of the costs incurred in
printing and storing medical information on paper.
Dr. Jeff Bauer - An Insider's Forecast for the Future of Health Care - Page 2
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"ocrText": "Lister, and Koch. Science-based medicine was quickly enshrined through state licensing laws, and\nit maintained its power for almost one hundred years.\nA backlash against science and the cultural diversification of the American population have\nrecently laid the foundations for diverse approaches to health care-including many which are not\nscience-based. The future will be remarkably eclectic in comparison to the past. accepting clinical\npractices that would never pass the tests of the scientific model. Alternative medicines have\njoined the pantheon of practice, and those of us who still prefer a scientific approach (the author\nincluded) will have to get used to the competition. The new health care system will offer lots of\nchoices that were underground only a few years ago. Caveat emptor.\nLEADERSHIP\nGiven the legal authority of scientific medicine in 20th century health care. medical doctors\nbecame the undisputed captains of the ship. Deciding what was wrong with a patient and what to\ndo about it was under the control of scientifically trained physicians. However, the creation of\nMedicare and Medicaid (1965) and the Viet Nam War created widespread fears of a doctor\nshortage. Academic medical centers responded by training a new class of caregivers like\nparamedics, nurse practitioners, and other so-called mid-level practitioners.\nThese nonphysician practitioners quickly demonstrated their high levels of clinical competence,\nand most states now allow them to practice independently of physicians. In other words, they are\nno longer junior officers on a doctor's ship. They will give us a choice of ships for our health care\njourneys. The new world of health care-one that will flourish regardless of conventional notions\nof health reform-will find many patients going directly to certified nurse midwives for normal\npregnancies. to clinical pharmacologists for adjustment of their drug regimens. or to massage\ntherapists for stress management. In other words, health care will now be led in many different\ndirections.\nCORE VALUE\nHealing touch is arguably the historic cornerstone of health care, witness the fact that health plans\nwon't pay unless a practitioner delivers the care in person (with the exceptions of radiology and\npathology). However, technological advances over the past decade have created the possibility\nthat good health care can be delivered without the caregiver and the patient being in the same\nplace at the same time. Telemedicine can permit a surgeon to operate on a patient hundreds of\nmiles away using a new technology called telepresence surgery, or it can allow a patient to be\ntested for diabetes with a home blood monitor that sends the results to a qualified clinician who\nwill review the record at a later time and consult with the patient by e-mail.\nThe exploding realm of e-health even gives us the option of filling prescriptions over the Internet\nand controlling our own medical records in a secure Web site. Health care at the beginning of the\n21st century is being increasingly liberated from the long-standing barriers of time and place. It\nallows patients and their providers to interact without being in the same room at the same time.\nFor a growing number of patients, the core value will become communications because being\nlistened to will be more important than being touched.\nKNOWLEDGE BASE\nIn the 20th century, the knowledge base was embedded in textbooks and journals that could only\nbe accessed and understood by someone who had graduated from medical school, and the patient\nhad to go to the doctor for health care because professionals controlled access to relevant\ninformation. In the 21\" century. the Internet and the World Wide Web open the vaults of medical\nknowledge to anyone with a computer and a telephone line. In addition, today's technologies\nallow the creation of a multimedia-rich medical record at a fraction of the costs incurred in\nprinting and storing medical information on paper.\nDr. Jeff Bauer - An Insider's Forecast for the Future of Health Care - Page 2"
}