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1. Medicine as Ecoculture

   • James Webster, MD

   Northwestern University, School of Medicine

   Dr Gillick’s brilliant analysis (1) resolves many of the enigmas that physicians observe in their practice environments, but the conclusions simply discuss possible measures for reform in very general terms. Only by initiating a physician led, “bottoms up”, total restructuring of how care is organized, delivered and most importantly, reimbursed, can the culture be significantly changed. An initiative to establish integrated, transparent, multispecialty groups as the national standard for practice, promoting Accountable Care Organizations with closed end budgets and a focus on Patient Centered Medical Homes would be an excellent start that the ACP should lead. This would eventually end the fee for service mentality that is destroying the integrity of the profession, and bankrupting health care. Now that would really improve the ecosystem!

   References

   1. Gillick MR. Medicine as ecoculture. Ann Inern Med. 2009;151:577- 580

   Conflict of Interest:

   None declared

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   Published October 26, 2009