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It’s Good to Get Personal - With Your Doctor

I've been a primary care physician, working mainly with the elderly, for 20 years. In that time, I've seen thousands of patients and witnessed tremendous medical advancements. And I've come to realize that a personal relationship with a patient is the most valuable tool a doctor can wield.

As the debate heats up over healthcare reform, I'm worried that personalized medicine will be compromised. Comprehensive healthcare reform is certainly needed. Costs are spiraling out of control and the number of uninsured Americans continues to rise. But in our efforts to fix what's broken, we must be careful not to break the things that work.

Reform-minded policymakers are putting a great deal of stock in "evidence-based medicine" and "comparative effectiveness research." These systems collect and compile scientific studies on medical treatments and then rank their effectiveness at treating particular diseases. Both are valuable resources when patients and physicians assess the merits of unfamiliar treatments.

But if public and private insurance plans use evidence-driven medical research to tie the hands of doctors, rigidly mandating treatment regimes based purely on cost, patients will be harmed. That's exactly what we're seeing with Britain's comparative effectiveness program - severe restrictions on treatment choices and hamstrung medical innovation.

I fully support improving the methods with which information is collected and distributed. Doctors, patients, and the healthcare system at large would certainly benefit from more information.

But to dispense care effectively, doctors must have the freedom to mix that information with our experience and our personal knowledge of our patients. Evidence shows that such freedom actually contains healthcare costs in the long run.

Consider avoidable hospitalizations. Generally, they are caused by Ambulatory Care Sensitive Conditions (ACS), which are illnesses that with the proper medical care would normally not require hospitalization. Typical ACS conditions include bacterial pneumonia, diabetes, asthma, and congestive heart failure.

Cutting down ACS-induced hospitalizations would translate into huge savings for the healthcare system. A recent study by the Partnership for Health and Accountability found that Georgia alone spent nearly $1 billion in 2003 on roughly 120,000 preventable hospitalizations.

Personalized physician care at regular intervals combats disease progression, preventing complications and costly hospital stays.

The American healthcare system currently puts disproportionate focus on treatment cost. An effective cost-containment strategy would emphasize early disease management and preventative medicine. This requires personalized care.

The most-promising patient-centric approach to care is called a "medical home." This is when a single primary care physician functions as the point of contact between a patient and the medical community. This physician is intimately familiar with the patient's medical history and particular needs. He knows what will work and what will not. And his decisions aren't restrained by out-of-touch and arbitrary policies.

As we reform our healthcare system, policymakers must remember that while medical research is a science, practicing medicine is an art. And all art is personal. The one-on-one relationship between a physician and a patient must be preserved and protected.

[Gary Applebaum, M.D., is a senior fellow at the Center for Medicine in the Public Interest. He is the former Executive Vice President and Chief Medical Officer of Erickson Retirement Communities.]

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