疲労ノッチrdius

1. 2010/09/24(金) 23:48:50|
2. 医療一般

どのように技術の効果肥満

1. 2010/09/24(金) 23:47:26|
2. 自治体病院

"関節炎薬アメリカンフォールズアイダホ"

1. 2010/09/24(金) 23:36:02|
2. 医師不足

1. 2010/09/24(金) 23:32:42|
2. 自治体病院

Earlier this summer a friend revealed that for the last nine years she has been a patient in a concierge, or boutique, primary care practice. For $350 each month, she is guaranteed around-the-clock access to her doctor, appointments within 24 hours of calling, longer office visits and the kind of personalized attention and care coordination she felt was missing with all her previous doctors.
"I love this doctor," she said. "He really knows me."
She recounted the details of a recent emergency room visit when a call from the doctor saved her from an unnecessary CT scan and admission to the hospital. "I feel like I have a doctor who's actually thinking about me and talking to other doctors on my behalf," she added.
But over the course of our conversation, I also discovered that her husband does not share her enthusiasm. He goes to a doctor in a more traditional primary care practice because he's uncomfortable with the idea that those who can afford it get better care, while those who cannot pay do not. "I just don't think it's right," he told me.
The two of them had agreed to disagree.
Agreeing to disagree has been what most of us, doctor and patient, have done since concierge, or retainer, practices first appeared in the mid-1990s. Developed as an alternative to the constraints of traditional practice, this new model allowed doctors to offer more personalized care that in turn increased patient and professional satisfaction. By decreasing the total number of patients seen in an office from well over 2,000 to as few as 500, doctors could offer longer visits, increased and immediate accessibility, personalized coordination of hospital care and, in some cases, even house calls and accompanied visits to specialists. In return for these services, patients would pay retainer fees, ranging from just under $2,000 to as much as $15,000 per year.
By 2003, according to a national survey, the number of doctors practicing concierge medicine numbered fewer than 200. And while critics raised ethical concerns about the "abandonment" of patients left without primary care physicians while their doctors downsized and the creation of a "two-tiered" system that exacerbated disparities in health care access, little was done to address those concerns. These boutique practices were a relatively rare curiosity, and practitioners were left alone.
But over the years and particularly in recent months, the debate about the ethics of concierge doctoring has grown more heated, with more and more physicians unabashedly lining up to take sides. An editorial in the Annals of Internal Medicine this spring, for example, questioned not only the ethics but also the quality of care delivered in such practices. The writer went on to urge other physicians to abandon "the neutrality with which the medical community has addressed" this issue thus far.
A month later, over a hundred doctors at a national meeting eagerly attended an event billed as a debate on the ethics of retainer medicine. But they weren't jostling for places to argue the ethics; they wanted to hear about the experiences of physicians who were already successfully practicing concierge medicine and to solicit advice.
As this issue becomes increasingly divisive, it's hard not to wonder whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns.
One group of doctors in Boston believes it is possible. And in an article published this summer in the journal Academic Medicine, they argue that it can be done to the benefit of doctors and all patients, boutique or otherwise.
（後略）