Go on a tour of a “midsized academic health center” with Dan Shapiro, chair of the Department of Humanities at Penn State College of Medicine, by reading his essay in the current issue of Health Affairs. Excerpt:
“It doesn’t make sense to me that we live and die by our procedure-based departments. Lifestyle is implicated in many if not most diseases, from diabetes to heart disease and some cancers, but the experts in helping patients change their behavior–our primary care and behavioral scientists–are poorly compensated. It is, in short, depressing.
We do stomach stapling, but won’t invest in teaching young, mildly overweight patients how to eat inexpensive, healthier food that can still taste good or how to distinguish anxiety from hunger. We’ll reimburse cardiac surgeons for numerous invasive interventions, but, aside from a few demonstration projects, we won’t reward doctors who successfully get their patients to lose weight. We pay physicians to do complex procedures, but then we don’t follow up to make sure our patients have even picked up their medications.
Are we reimbursing procedures better because they take more skill? Is it truly harder to install a titanium hip joint than to help patients drop pounds or consistently do weight-bearing exercise? Is it harder to blow open an artery than to help a person quit smoking? I respect the skills of my surgical and procedural colleagues, as well as all of the specialists who walk our halls. But I also know it’s incredibly hard to help kids identify and avoid what triggers their asthma, and I know that it takes special skill even if it looks like “just talking.”
Perhaps it’s because we think procedures are riskier, and physicians who do procedures should be rewarded for their courage. But is overcoming risk in the quiet of the operating theaters truly more courageous than working in an asthma clinic, helping a flood of patients with limited resources navigate the challenging waters of a life-threatening breathing disorder?”