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A panel of Alpert Medical School doctors and students discussed the inadequacies of current health care delivery systems Friday in Sayles Hall.

The event — the first of three lectures in the Paul Levinger Health Care Reform Roundtable Series — featured Edward Wing, dean of the medical school and Lt. Governor Elizabeth Roberts '78. The panelists, including Professor of Medicine Thomas O'Toole, Associate Dean of Medicine for Public Health Terrie Wetle, Zachary Ginsberg MD/MPP '10 and Chima Ndumele GS, addressed a large audience of physicians, faculty and students.

Wing said too many health-related problems are tackled in the emergency room first. "I'm a fan of primary care," Wing said. "It is the heart and soul of medicine. It's the starting point."

Primary care physicians should build relationships with their patients and educate them to change their lifestyle choices to prevent diseases, he said.

"We let patients off the hook. They're responsible for their own health," he later added.
But both Wing and Roberts said primary care lacks adequate resources. "We're not thinking enough about delivery systems," Roberts said. As an example she pointed to a "major revelation" among many in neighboring Massachusetts that there were not enough primary care providers for the influx of new patients brought into the system after health care reform in the state. 

Wing believes a greater proportion of the money spent on health care ought to be spent on primary care. The United States spends "seven percent of health care dollars on primary care," he said. "The optimum is 12 percent. In Rhode Island, we spend five percent. It's a disgrace." 

It is unfair, Wing said, that physicians are paid more when they recommend more tests. "The way they are incentivized to do their business is out of control," he said. During the panel, Ginsberg said physicians both supplied and created the demand for health care.

"It's a flawed economic system, and it doesn't function rationally," he said. 

Roberts said she expected to see "people wanting some accountability in terms of quality in medical practice."

"We are not smart consumers of health care," she added. 

Wing and Roberts expressed their confidence in the medical home model, in which patients receive comprehensive care from primary care physicians.

Roberts said she expects "a diversity of approaches" in health care delivery to emerge after reforms pass through Congress. But she and Wing agreed that health insurance reform rather than health care reform is the focus of legislators in Washington. "I'm not sure how productive that is," Wing said.

Addressing the doctors in the audience, Roberts said, "The medical community has to be in the middle of this discussion. It's really vital that we don't make assumptions about the work that you do without your input and involvement." 

O'Toole emphasized the importance of "teaching our students to think about systems, the milieu they will be practicing in." He also stressed the need for doctors to be effective communicators and to work together. "We need to be considering what it means to be working as a team," he said. 

A basic concern is whether health care is considered a right, Roberts said.

"I think it's a fundamental question for the country and for each of us," Wing said. 

Roberts said an influx of patients into the health care system presents the chance for major changes in health care delivery.

"We have the opportunity to make smart changes," she said, "We also have the opportunity to do it wrong."


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