American Health Care

"There is great concern about health care in America and all are interested in the costs and complexities. Many plans for change are suggested. With a lifetime of practicing and teaching medicine, Dr. Fuller explains the need to reconsider responsibility to the patient. The magnitude of changes in the practice of medicine in one professional lifetime is not often fully appreciated. Enthusiasm generated by the new discoveries has not been matched by a willingness to learn how to use them effectively. There is no doubt that the health care system in the United States needs to be carefully examined and changed, but the health care plans have a common weakness - while all plans are strong advocates of using primary physicians in a leading role, none of them show an understanding of what the role of primary physicians should be in modern medical practice. They only view primary physicians as "gatekeepers" to be used to control utilization by controlling access more or less arbitrarily.^ They fail to understand the key role primary physicians must play as managers of total care of their patients at all levels of patient care. The wide variations among patients with the same disease is being forgotten. Deciding on a diagnosis and then on appropriate treatment for each patient must be highly individualized most of the time, based on the patient's overall health status as well as on many psychological and social factors. Primary physicians should be able to assume the heavy responsibilities of patient care management in the context of modern medical practice. Physicians who are trying to make proper decisions for their patients, to treat them as wisely and as inexpensively as possible, are finding themselves harassed and handicapped by other sources trying to take control from a distance. This is becoming a critical and frustrating problem in medicine today.^ Who is in control of the multiple decisions to be made? Is it primary physicians, specialty physicians, or third-party payers? No one seems to know. Defining the responsibilities of primary physicians and how they must be prepared for them is what this book is all about."--BOOK JACKET.