Question: How does the media affect the practice of medicine?
Ezekiel Emanuel: Oh just hugely! I mean what is a problem? How they address problems; how they can sometimes do tremendous job educating people about the complexities of the problem; how sometimes they can do a terrible job because of the shortness . . . that they don’t allow the complexities and the subtleties to get through. In general actually, I think reporters have really been very interested in trying to understand the details. I would say that the second problem with the media is the attention span problem. That’s a general problem in our culture. You gotta say it in 250 words or less; but also once you’ve said it, you know . . . How much coverage do we now have today in July 2007 on pandemic flu? The threat hasn’t gone away. If anything, the threat has gotten worse. And yet, you know, you talk to a reporter, “Well we did that last year.” You know? And that, I think, is a terrible problem. Because some of these problems require a long-term focus on an issue. Healthcare reform is another really big issue, which you’re not gonna solve it in a year. You’re not gonna solve it in the next five years. It’s gonna take a long time to focus on the problem; and yet the media doesn’t have that attention span.
Question: What is the biggest challenge medicine faces?
Ezekiel Emanuel: Well medicine in the United States, I think, faces a real disaster in its delivery system. We know that we’re not delivering care well in that we can’t reliably guarantee Americans will get quality care when they enter the hospital. That in fact it’s almost a 50/50 flip of a coin for people, whether they get the right care or the not right care. That is a disaster. And to change the system to make sure that delivery is better, and that we’re really doing better by people and actually doing it efficiently is a huge challenge at the moment. And I think that, without a doubt, is the biggest challenge facing American medicine. And that’s really gonna, in my view, require comprehensive change of the system. We can’t sort of fix a little here and a little there. I don’t even think getting all Americans ensured is a solution. We actually . . . That’s one small element, but we actually have to control costs. Otherwise in a few years, we’re gonna have uninsured. We also have to improve quality. So that’s a very complicated puzzle. And you just think that American healthcare system costs two trillion dollars – sixteen percent of the GEP – fixing that obviously is a huge, huge challenge. And so I think without a doubt, the medicine, that’s the biggest challenge.
Obviously there are lots of diseases we haven’t solved. Lots of diseases that we don’t even have therapies for. Those are big challenges, but nothing compared to delivering what we know works today efficiently and effectively to all Americans. That is a huge undertaking in management, really.
Recorded on: 7/4/2007 at The Aspen Ideas Festival
Discuss
jill conklin on January 17, 2008, 8:00 AM
Being involved with the health care system as practiced in the United States for the past 3 decades, I think it safe to say; 1)absolutely delivery has to be improved. Access must be better, the correct point of service for the problem be utilized (ie- an office or clinic vs an emergency department for non-emergent care), and timeliness in addressing medical issues allowed for. The lay public needs greater education and involvement. 2) Frivolous litigation should be disallowed. Cases should meet stringent guidelines for litigation to proceed, with the foreknowledge that, despite the best intentions and correct judgements, things do occassionally go wrong and folks can suffer morbidity or mortality as a result, 3) staffing of medical institutions must reflect patient census' quantity and quality, 4) costs need to be controlled, primarily equipment, supply, and pharmaceutical costs, and to a lesser degree, salaries, 5) greater emphasis should be placed on preventative care, including non-traditional therapies which better attend to the person as a whole, and 4) those involved in the delivery of medical services need most importantly to take into consideration the vulnerabilities of the patients, and not exploit those vulnerabilities. Resounding ethical and moral decline is evident in all aspects of society today, and each individual need take responsibility to practice in an ethical manner.
Ryne Cee on January 17, 2008, 12:54 PM
While I agree with most of the original poster's points I have to contend that the attention span of the media directly reflects the population who consumes it. For example, the healthcare plans of 2008 presidential candidates are given a few tag lines: buy into a public health care plan, socialized medicine, etc… because that is the capacity with which the audience is comfortable engaging. For all the lambasting of the media, we have to look to ourselves as a society of consumers whose scant attention to any topic has led to the state of reducing topics to a sound bite.
jill conklin on January 17, 2008, 1:00 PM
Being involved with the health care system as practiced in the United States for the past 3 decades, I think it safe to say; 1)absolutely delivery has to be improved. Access must be better, the correct point of service for the problem be utilized (ie- an office or clinic vs an emergency department for non-emergent care), and timeliness in addressing medical issues allowed for. The lay public needs greater education and involvement. 2) Frivolous litigation should be disallowed. Cases should meet stringent guidelines for litigation to proceed, with the foreknowledge that, despite the best intentions and correct judgements, things do occassionally go wrong and folks can suffer morbidity or mortality as a result, 3) staffing of medical institutions must reflect patient census’ quantity and quality, 4) costs need to be controlled, primarily equipment, supply, and pharmaceutical costs, and to a lesser degree, salaries, 5) greater emphasis should be placed on preventative care, including non-traditional therapies which better attend to the person as a whole, and 4) those involved in the delivery of medical services need most importantly to take into consideration the vulnerabilities of the patients, and not exploit those vulnerabilities. Resounding ethical and moral decline is evident in all aspects of society today, and each individual need take responsibility to practice in an ethical manner.
Ryne Cee on January 17, 2008, 5:54 PM
While I agree with most of the original poster’s points I have to contend that the attention span of the media directly reflects the population who consumes it. For example, the healthcare plans of 2008 presidential candidates are given a few tag lines: buy into a public health care plan, socialized medicine, etc… because that is the capacity with which the audience is comfortable engaging. For all the lambasting of the media, we have to look to ourselves as a society of consumers whose scant attention to any topic has led to the state of reducing topics to a sound bite.
Rob Robertson on January 27, 2008, 10:00 AM
Unfortunately I cannot comment on whether anyones ideas about US health care should change as I am a Canadian but I can comment on jillybean's 5th point. I do believe in preventative medicine but I do not think anyone, Canadian, US or any other country should put health care dollars toward alternative medicine as most of it is ineffective and misleading to those who seek treatment. Any worthy alternative technique should be scientifically tested against placebo and/or current treatment, with costs vs benefits clearly shown. This has been done in a few cases and the "alternative" medicine has turned into western, scientific, medicine. for instance aspirin was developed from the bark of a tree. Acupunture applied to neuroanatomical sites, and not through meridians, can help to reduce pain. I feel to be more "holistic" health care workers need to spend more time with their patients, and think outside of their respective specialties and be more general. Check out www.quackwatch.com to read up on why certain alternative medicines seem to work. Its great.
Rob Robertson on January 27, 2008, 3:00 PM
Unfortunately I cannot comment on whether anyones ideas about US health care should change as I am a Canadian but I can comment on jillybean’s 5th point. I do believe in preventative medicine but I do not think anyone, Canadian, US or any other country should put health care dollars toward alternative medicine as most of it is ineffective and misleading to those who seek treatment. Any worthy alternative technique should be scientifically tested against placebo and/or current treatment, with costs vs benefits clearly shown. This has been done in a few cases and the “alternative” medicine has turned into western, scientific, medicine. for instance aspirin was developed from the bark of a tree. Acupunture applied to neuroanatomical sites, and not through meridians, can help to reduce pain. I feel to be more “holistic” health care workers need to spend more time with their patients, and think outside of their respective specialties and be more general. Check out www.quackwatch.com to read up on why certain alternative medicines seem to work. Its great.
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