Letter: A doctor responds to ideas to improve health care

April 01, 2014

From: Magazine

Primary-care physicians must do more to ensure our patients feel more reassured, relieved, and rejuvenated after paying us a visit. During my 20–year career in medicine, I have been a family physician working in the diverse arenas of San Francisco city clinics and hospitals and in clinical research; a corporate medicine consultant; and, for the past 12 years, a doctor performing home visits on the South Side of Chicago. I have heard my share of complaints from patients about my fellow physicians' bedside manners and the general state of our health-care system. I felt reassured, relieved, and rejuvenated after reading "This Won't Hurt a Bit" (Winter 2013/14).

In response to the story's idea of helping doctors use new drugs, I have this to add: I can still hear one of my professors at San Francisco General Hospital saying, "You want to approach new drugs with deliberate speed and wait a year or so to see how the new kids on the block treat their neighbors." Some new drugs are truly miraculous, and we owe the R&D teams a debt of gratitude, but until Big Pharma does a more thorough integrity check (e.g., drugs such as Vioxx and fen-phen never should have reached consumers), I still feel it is wise to hold off on giving the newest drugs too soon. 

As for the idea of creating preventive drugs, I wholeheartedly agree. This is where one of the real remedies lies. I would advocate even earlier interventions with intensive lifestyle changes, such as Dr. Dean Ornish's Program for Reversing Heart Disease, which was recently approved by Medicare. This program demonstrates how a low-fat diet, exercise, yoga, and group support for patients with heart disease can help them avoid high-risk procedures such as angioplasty and bypass surgery and potentially save hundreds of thousands of dollars. In the words of Dr. Ornish, my mentor, "We have to stop frantically trying to mop up the wet floor and go over and turn off the faucet." 

Damien J. McKnight, MD
Visiting Physicians, Chicago
Medical Director, United Health Care
Former Medical Director, Preventive Medicine Research Institute