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Chapter 6 : The Changing Practice of Medicine

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Abstract:

Societal changes, changes in technology, and changes in expectations have all come together to create a landscape vastly different for both practitioners and consumers of healthcare over the last two decades. The practice of medicine has changed in response to new discoveries in medicine and science but is being shaped by external pressures such as rising costs, increasing competition, and a new emphasis on customer satisfaction in the informationsavvy patient. The training programs that educate future physicians have been restructured to prepare students for the practice environment they will soon enter. The laboratory, always at the forefront of quality issues, is the perfect paradigm of changes going on at a more global level in healthcare. The chapter identifies the changes in medical school and residency curricula intended to prepare physicians for medical practice in the 21st century. New medical discoveries are made at a dizzying pace. Keeping up with these changes has always been challenging for physicians. The development of clinical practice guidelines is prioritized based on the prevalence of the clinical problem, burden of illness imposed, cost, variability in practice, potential to improve healthcare outcomes, and potential to reduce cost. The laboratory is usually just a small segment of the hospital’s business overall and is lumped into other reports. Finally, the laboratory is usually a part of a larger organization that may not keep their laboratory data separated. The major cost containment and medico-legal issues faced by physicians and laboratorians are outlined.

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6

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Tables

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Table 6.1

Themes of change

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.2

Impact of the internet

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.3a

Pros and cons of clinical practice guidelines and clinical pathways

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.3b

Pros and cons of clinical practice guidelines and clinical pathways

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.4

Elements for developing clinical pathways

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.5

Highlights of the Help Efficient, Accessible, Low Cost, Timely Health Care Act of 2002

See reference 34.

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.6

Program oversight functions from the Medicare Integrity Program

See reference 11.

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.7

Framework for federal privacy legislation (HIPAA)

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.8

Requirements of written request for confidential patient information

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.9

Essential elements of a legal contract

See reference 11.

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
Table 6.10

Ethical principles and moral obligations governing the patient and healthcare organization's relationship

See reference 11.

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
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APPENDIX 6.2a Example of a Clinical Pathway: Community-Acquired Pneumonia Clinical Pathwaya

Provided courtesy of Stephen Sigworth,Virginia Commonwealth University Health System.

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6
Generic image for table
APPENDIX 6.2b Example of a Clinical Pathway: Community-Acquired Pneumonia Clinical Pathwaya

Provided courtesy of Stephen Sigworth,Virginia Commonwealth University Health System.

Citation: Roseff S, Nichols B, Grimes M. 2004. The Changing Practice of Medicine, p 135-159. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch6

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