GM1-12

In reply to Metasphere http://cmatalks.blogspot.com/2010/12/gm1-10.html

I don't believe that physicians do not want to see more physicians trained. However, there are gluts in some specialties and shortages in others. We are short of family doctors and so there should be family medicine programs whereby the entrants become family doctors. The University of Calgary is piloting just such a program.

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GM1-10

One thing I would do is triple med school enrollments.

But the doctors won't want to hear that.

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GM1-3

In reply to Elder Gonzo http://cmatalks.blogspot.com/2010/12/gm1-1.html

At first glance this might seem like a great suggestion. However, in Alberta where I am from it is unlawful for a physician or pharmacist to fill a prescription for more than 18 months without the patient being re-assessed by a physician to see if the patient is still on the right medication at the right dosage for the right reasons. Now, given that the majority of us get our cars checked out at at least yearly intervals, I do not think it is unwise to go to the doctor and have him ensure we should still be on the same blood pressure medication at the same dosage. It would negligent for him/her to call in a prescription to the pharmacy without even laying eyes on you. Would you let your mechanic order parts for your car without checking it out?

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T1-158

In reply to Purley http://cmatalks.blogspot.com/2010/12/t1-117.html

RE: +train the physician to perform in this arena in a "Z" structure under his/her management

Is is worth explaining that the vertical line is the physician as the knowledge worker connected to the " system" ( the top horizontal line) and his/her client base ( bottom horizontal line)

Technology has birthed the necessity for the TOP horizontal line to connect DIRECTLY with both the non-medical care provision needs of the client/patient AND for the physician to connect directly with IT related to funding for primary care services.

It is the purview of the physician to grow into how he/she performs as mainly a knowledge worker assisted by technology to serve a larger client base. It is the traditional role of the physician to lead the development of the BOTTOM horizontal line where medical provision of services is delivered.

It is the responsibility of the payor to update/create legislation that governs the TOP horizontal line.

It is the responsibility of the physician to justify to his investors ( government and client payors) how his practice meets their requirements.

This TOP horizontal line is where the " feeding frenzy" is ........... PRIMARY care

Note:

The vertical line of the physician is oblique ...where the patient accessing the physician from a top down approach does not necessarily connect with medical care as a first step.
[This position must also be supported by an algorithm]

Therefore in order to access the physician directly the patient is bypassing the topline already and going straight to guaranteed access to physician care....i.e. SECONDARY care levels

This secondary care level is in it's first stages of restructuring to embrace the client/patient who refuses to use the jumble of primary care portals .
[politicos better hasten to adjust this structure into "program cells that float in a medium" in order to prevent rapid escalation of cost in secondary care levels ]

Who will clean up the TOP horizontal line?... it must be the politician..... not the physician.

KEY: It must ultimately be structured so it's success can compete internationally as " care" offsets become as valuable as " carbon" offsets in trading value.
It is the TOP line that deals with the " dependent" variable...which is NOT the client/patient... is NOT medical care.....
IS..... the service delivery structure itself.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-158

T1-117

In reply to Purley http://cmatalks.blogspot.com/2010/12/t1-86.html

continued....

It is worth considering what you do when experimenting.
You have dependent and independent variables and you measure the unknown against the known.
The mistake made in planning, structuring, delivering, medical health care is the costing focus is on the unpredictable...versus the predictable.
When a patient is institutionalized the stable costing components are on the non-medical components of care. The elements that can be predictably costed, staffed, and improved over time .
It is the funding of the NON-medical components of health that will stabilize the SERVICE environment for the patient/client.

It is the funding of the physician ( not overriding umbrellas clustering private ambitions) that will stabilize the funding environment for the payor. To effect this the physician must adopt a system that enables him/her to perform as a KNOWLEDGE worker ... not simply a prescription writer in someone else's stable.

Face it......... if you remove the physician and the patient form all of these struggles........ the entire remaining structure has no purpose .... and it falls to nothing.

How to do this?
+Seperate primary care totally from the three other levels ( secondary, tertiary, quaternary).
+Fund direct patient/physician interraction at the secondary care level ( hospital setting )
+Let the primary care level learn to stabilize it's function based on HOW they deliver the STABLE components ( non-medical services)
+train the physician to perform in this arena in a "Z" structure under his/her management
+establish a predictable service package directly connecting frontline workers to client/patient

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