vmontori

Some disambiguation will be required.

This is a hard question. Some medical conditions appear to not be worth the same level of access and care than others. Conditions that remain hard to explain with medical science, mental and behavioral health conditions that are hard to treat successfully or that require multidisciplinary teams or that are poorly reimbursed by payers. Patients who suffer these conditions not only have to cope with the challenges of living with them, of adapting to its symptoms and limitations and thriving as they pursue their life's hopes and dreams but they must also work hard, fight sometimes, to get the care they need. This is neither careful nor kind. It is often downright cruel.

The Patient Revolution does not focus on advancing the situation of people living with any specific disease or condition, but rather with creating a healthcare system that can respond humanly to the situations patients bring. As science advances, clinicians may find themselves in increasingly better position to respond effectively. In the meantime, they should care. The Patient Revolution should help make it more likely than not that the way healthcare is "delivered" and funded does not interfere with the ability of clinicians to care, and of the patients to see their situation advanced by care.

The affordable care act was one way to address the problem of how to pay for access to care for all Americans. There are other ways to achieve that goal. Whatever the approach, it should cover everyone who is here and be based on solidarity, not on greed. Legislators voted into office have the right to act on behalf of their constituents, so repeal - simply getting rid of a mechanism to provide access - is not a solution. A solution would require meeting requirements for access to timely, effective, safe, evidence-based, equitable, and patient-centered care and ensure this care is accessible and usable for all. The affordable care act got us closer, but not close enough. Efforts to repeal take us backward and seem careless. My concern is not with the industry, but with the ability of those most vulnerable to pursue their hopes and dreams unhindered by their health or by healthcare. The solution, therefore, cannot be limited to who pays (single payer vs. multiple payers) but what kind of care should every one of us expect when illness surprises us or gets in our way.

Very challenging. The narrow definition of personalized medicine is one based on careful measures of bodily function, chemicals, bugs, proteins, or genes. These are efforts to reduce uncertainty. I think we need to recognize that the most likely outcome of these efforts will be the recognition of new uncertainties. I am afraid they will distract us from practicing the “other” personalized medicine which is to see each person in high definition, see their biology and biography, their content and context.

Several layers here. Care takes time but we should think of this time not as simply the result of more “units of production” but of ways of caring that may require fewer encounter because we would work harder at improving health on one end and we would have unhurried encounters in which problems are more likely to be diagnosed more accurately and treatments make more sense to both the patient and the clinician. Those encounters should not be crowded out by business agendas, documentation and billing.

On the other hand healthcare should not be a place where people come to extract profits and greedy levels of income. This statement applies to corporate leaders, managers, and clinicians. So I would expect that salaries - yes salaries - for clinicians and others in healthcare including CEOs be moderate, return on investments reasonable not exorbitant and “breakthroughs” measured in human lives improved and saved and not in number of dollars pocketed.