Making Primary Care The Primary Focus
Ronald Dixon, M.D., M.A, is the Associate Medical Director at Massachusetts General Hospital (MGH) Beacon Hill Internal Medicine Associates, and the Director of the Virtual Practice Pilot at Massachusetts General Hospital.
Dr. Dixon completed his undergraduate work at McGill University, graduate work in clinical neuropsychology at University of Buffalo, and medical training at Dartmouth Medical School. He completed residency training at Massachusetts General Hospital. He recently completed an Administrative Fellowship with the Massachusetts General Physicians Organization (MGPO), and currently serves as a Project Director for the MGPO.
Dr. Dixon’s interests are in alternative methods of health care delivery, specifically relating to general internal medicine. Dr. Dixon sits on a number of committees designed to make care delivery more efficient and effective for patients and physicians. He is actively pursuing clinical practice based research in this domain, supported by the MGH and the Center for the Integration of Medicine and Innovative Technology (CIMIT). His current projects include ‘Virtual Visits in General Medicine,’ ‘Primary Care Kiosks,’ ‘Low Acuity Clinics,’ and ‘Remote Physiological Monitoring in Patients at Risk for Chronic Disease.’ Dr. Dixon’s clinical interests are disease prevention, behavior management, chronic disease management, and care of patients with malignancies.
Topic: Fixing healthcare.
Ron Dixon: There are a number of things that could address this problem. I think the primary one is the role of so-called primary care as the front line for healthcare delivery, really needs to be reinvented. There are several opportunities to innovate around what a so-called primary care physician does.
Unfortunately, since the current model rewards physicians for actually doing things, such as procedures, as opposed to thinking about things and coordinating things, we don’t really have a workforce that is engaged in thinking innovatively about primary care and primary care delivery.
If you are able to start thinking about paying for efficiency, paying for so-called performance, paying for coordination of care and paying for a person who acts as the pinpoint for the patient, paying in a way for that relationship between that primary care provider and the patient, then you would have a way to build some efficiencies into the system.
Question: What is patient-centric care and why does it matter?
Ron Dixon: I think patient-centric care is really the ethos of primary care. We as general internists, pediatricians and family doctors are really interested in doing what’s best for the patient. I think that can become rather difficult given the pressures put upon us by folks who actually pay for the care, because sometimes they might be more interested in what is the actual cost of providing care for a population.
There are two counter-intuitive forces at hand here. You want the best care for your patient who is sitting in front of you, who might be a diabetic, but then you also want the best care for the population of diabetics within a practice.
Primary care doctors don’t really have the tools to provide both, and what we end up doing is providing patient-centric care, but not in the way that we would like to do it, simply because we don’t have the time to really sit and talk with patients and think about informed decisions. We want patients to have the information and then be able to make shared decisions with the primary care doctor as the person who’s sharing that decision with the patient.
So, that would really be what patient-centric care is about. Unfortunately, in today’s environment we don’t typically have time to practice it.
Well, right now again we’re paid for what we do, which is actually perverse incentive, so it makes us do more. That’s one of the reasons I think you’re seeing the cost of healthcare rise 8% in terms of inflation per year. Now, that obviously can’t continue, and [Barack] Obama has some proposals on the table to reduce that increase by 1.5% per year over the next few years.
I think however, if you start to pay for performance, pay for quality, pay for efficiency, then you eliminate these types of incentives.
If a patient has diabetes and can self manage their blood sugars, which a lot of patients do, but now we have a tool which enables the physician or the care provider to actually see those self management values and work off of those to help coach the patient as to how better manage their blood sugars and behavior, then it doesn’t matter where that management is taking place. If that management is taking place at the home, but the outcome in terms of quality is good or better than the visit-based model, then you have incentives to provide this type of care.
Recorded on: May 28, 2009.
Medical expert Ron Dixon says we need to eliminate perverse incentives from healthcare and start paying for performance and quality.
Physicists create quantum entanglement, making two distant objects behave as one.
Poland has become an increasingly unwelcoming place for the LGBTQ community. 50 diplomats hope to change that.
- An open letter, signed by 50 ambassadors and NGO leaders, asked the Polish government to respect LGBT rights.
- The Polish Government responded by denying the implied discrimination exists.
- Poland has been deemed the "worst place to be gay" in the EU in spite of this.
Strongly worded letters, the weapon of champions.<p> Organized by the Embassy of the Kingdom of Belgium in Poland, the <a href="https://pl.usembassy.gov/open_letter/" target="_blank" rel="noopener noreferrer">open</a> <a href="https://pl.usembassy.gov/open_letter/" target="_blank" rel="noopener noreferrer">letter</a> was signed by the Ambassadors of 43 nations representing most of Europe and all of continental North America, as well as several countries from Asia, Africa, and South America. Representatives of various international organizations, including the United Nations High Commissioner for Refugees, also signed. </p><p>The letter pays tribute to those working for LGBT+ rights in Poland and affirms the dignity found in each person "as expressed in the Universal Declaration of Human Rights." It goes on to remind the reader that "respect for these fundamental rights, which are also enshrined in OSCE commitments and the obligations and standards of the Council of Europe and the European Union as communities of rights and values, obliges governments to protect all citizens from violence and discrimination and to ensure they enjoy equal opportunities."</p><p>It ends with the declaration, "Human rights are universal and everyone, including LGBT+ persons, are entitled to their full enjoyment. This is something that everyone should support."</p><p>The American Ambassador to Poland, Georgette Mosbacher, <a href="https://twitter.com/USAmbPoland/status/1310276250993405954?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1310276250993405954%7Ctwgr%5Eshare_3&ref_url=https%3A%2F%2Fwww.them.us%2Fstory%2F50-countries-sign-letter-condemning-polands-lgbt-free-zones" target="_blank" rel="noopener noreferrer">retweeted</a> the letter and added, "Human Rights are not an ideology - they are universal. 50 Ambassadors and Representatives agree." </p>
The Response of the Polish Government<iframe width="730" height="430" src="https://www.youtube.com/embed/EBthKt2Of9U" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p>The Polish Government was less than pleased with the letter and its implications. <br> <br> The Prime Minister of Poland, Mateusz Morawiecki, rejected the letter and its implications, saying "nobody needs to teach us tolerance, because we are a nation that has learned such tolerance for centuries and we have given many testimonies to the history of such tolerance."<strong></strong></p><p><strong> </strong>This sort of rebuttal is nothing new; just last week, when American Presidential Candidate Joe Biden <a href="https://twitter.com/JoeBiden/status/1307831910089990144" target="_blank">tweeted </a>that "LGBT-free zones' have no place in the European Union or anywhere in the world," the <a href="https://wyborcza.pl/7,173236,26327279,polish-embassy-to-biden-no-lgbt-free-zones-exist-in-poland.html?disableRedirects=true" target="_blank" rel="noopener noreferrer">Polish Embassy in the United States </a>was quick to say the tweet was based on inaccurate information, to reassure the world that there are no such zones, and to restate their belief there is no place for discrimination in society. <br> </p><p>A quick fact check demonstrates otherwise. Several places in Poland have declared themselves to be "<a href="https://www.bbc.com/news/stories-54191344" target="_blank" rel="noopener noreferrer">LGBT free zones,</a>" violence inspired by anti-LGBT+ propaganda has taken <a href="https://www.nytimes.com/2019/07/27/world/europe/gay-pride-march-poland-violence.html?action=click&module=RelatedLinks&pgtype=Article" target="_blank" rel="noopener noreferrer">place</a>, l<a href="https://www.nytimes.com/2020/07/30/world/europe/LGBT-free-poland-EU-funds.html" target="_blank" rel="noopener noreferrer">eading government figures</a> have declared homosexuality to be a "threat to Polish identity, to our nation, to its existence and thus to the Polish state," and the President of Poland, Andrzej Duda has declared the LGBT movement to be more dangerous than <a href="https://www.bbc.com/news/world-europe-54317902" target="_blank" rel="noopener noreferrer">Communism</a><a href="https://theconversation.com/how-a-gender-conspiracy-theory-is-spreading-across-the-world-133854" target="_blank" rel="noopener noreferrer">. Surveys</a> show nearly a third of Poland's people believe in a grand conspiracy against them involving "<a href="https://en.wikipedia.org/wiki/Anti-gender_movement" target="_blank" rel="noopener noreferrer">gender ideology.</a>"</p><p>It is also worth repeating that Poland has been declared the worst place in the European Union for <a href="https://notesfrompoland.com/2020/05/14/poland-ranked-as-worst-country-in-eu-for-lgbt-people/" target="_blank" rel="noopener noreferrer">gay</a> <a href="https://notesfrompoland.com/2020/05/14/poland-ranked-as-worst-country-in-eu-for-lgbt-people/" target="_blank" rel="noopener noreferrer">rights</a>. Same-sex unions of any kind, including civil unions, are still illegal, and gay couples have no right to adopt children. Laws against hate crimes and conversion therapy are also notoriously lacking. Though to their credit, gay men and bisexuals can donate blood in Poland with greater ease then they can in the <a href="https://en.wikipedia.org/wiki/Blood_donation_restrictions_on_men_who_have_sex_with_men#Europe" target="_blank" rel="noopener noreferrer">United States. </a> </p><p>Despite having a first-hand understanding of the dangers of authoritarianism and intolerance than most nations, some in Poland continue to use the LGBT+ community as a boogeyman. While it is not the first time such things have been done, perhaps it will be one of the last. </p>
Researchers have just discovered the remains of a hybrid human.
90,000 years ago, a young girl lived in a cave in the Altai mountains in southern Siberia. Her life was short; she died in her early teens, but she stands at a unique point in human evolution. She is the first known hybrid of two different kinds of ancient humans: the Neanderthals and the Denisovans.
What do we want to do with convicted criminals? Penology has several philosophies waiting to answer that question.
- What is the purpose of punishing a convicted criminal supposed to be? It depends on which philosophy you prescribe to.
- None of these ideas are without their detractors, or qualifying evidence.
- As the United States grapples with criminal justice reform, the arguments each philosophy has behind it will have to be considered.