Page 19 - Delaware Medical Journal - January 2018

THE MEDICAL PROFESSION
• Fully embrace the physician role — not just the job of being a doctor.
Recommendations for Actions by Patients:
• Be aware that part of the physician’s role is to be your advocate.
• Participate in assessments of the effectiveness of advocacy and perceptions of expertise as well as satisfaction.
• Speak up if your interests are not being served.
• Recommendations for Action by Health System Leaders:
• Establish a culture that supports advocacy for patients by physicians, expects and rewards professional expertise, and encourages and incorporates innovation.
• Establish formal oversight procedures that protect patient interests and support physicians.
• Develop a culture that respects the important aspects of professionalism
REFERENCES
in the service of patients, including physician autonomy.
Recommendations for Action by Regulators:
• Reinforce and monitor current oversight systems (e.g. role of medical executive committees) and appeal procedures by individual physicians to a governing body.
CONCLUSION
Major changes in the practice of medicine during recent years have eroded physician autonomy. Our analysis of four specific trends suggests that patients, and often physicians, are likely to benefit from these changes, despite the loss of physician autonomy. The potential effects are not uniform, however, nor are the benefits certain. Benefits and risks both depend on the specifics of the implementation of change. The potential benefits to patients will accrue only if the changes to practice are well conceived and well managed. The details matter. Furthermore, appropriate actions by physicians,
health system leaders, regulators,
and patients themselves can manage potential negative effects of change for patients that appear to correlate with the physician’s loss of autonomy. Advocacy, expertise, quality, safety, and innovation need not be weakened. Rather, the expectation should be that they will be enhanced. Our analysis strongly suggests that improvement will not occur on its own, but the negative effects of current change easily could. We see our analysis, consequently, as a call to action, or rather a call to many actions that will preserve the vital important roles physicians play in the care of their patients.
CONTRIBUTING AUTHORS
■ ROBERT J. LASKOWSKI, MD, MBA is a Professor of Clinical Medicine at Thomas Jefferson University in Philadelphia, Penn.; Past Chair of the Board of Directors of the Association of American Medical Colleges, retired President and CEO of Christiana Care Health System in Newark, Del.; and Principal of Laskowski Advisors in Oak Bluffs, Mass.
■ JOSEPH LYONS, MA, CPA is Principal of Lyons Advisors in Philadelphia, Penn.
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