McGill principal calls for new model of health care
In a rapidly changing world, academic health care centres must re-invent themselves in order to remain relevant to society. A model to guide that process was recently proposed to an audience of health care professionals at Memorial by Dr. Bernard Shapiro, principal and vice-chancellor of McGill University.
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| During his visit to Memorial, Dr. Shapiro (l) had a tour of the Telemedicine Centre with Dr. Carl Robbins (r), vice-dean for professional affairs. |
"It is not a question of whether your enterprise will change, but rather how, when and -- most importantly -- by whom and at what price?" said Dr. Shapiro on Oct. 9 during the third in the series of 30th Anniversary Lectures.
"Public expectations have rarely been higher, and public confidence and support have rarely been lower. Complaints against the academic health professions include outmoded teaching models, fragmented fields of study, trivialized scholarship, disregard of patients except as subject of research or objects of professional practice, conflicts of interest, and falsification of experimental results -- to say nothing of the continuing public stereotype of physicians as self-indulgent, arrogant and resistant to change."
Dr. Shapiro said there is a vast difference between what the "internal" and "external" health care markets consider important. "The internal market has succeeded in a vast overproduction of specialists and a vast underproduction of everything else. There is a disjunction between what people inside feel would be helpful and appropriate and what people outside believe they need and can benefit from."
In the current model of health care, hospital facilities offer a range of medical services within confines of the institution. Dr. Shapiro proposed a new model that would involve a major revision of the role of hospitals in society and a change in the manner in which they discharge their mission.
He defined three "continuities" to re-define health care in the future. "The first conceptual shift -- perhaps easier for Memorial to do than for larger universities -- is not to think of hospitals as the central point of the restructuring process, but rather a significant component of the health care network. The network itself will encompass the entire spectrum of care from primary care in community through to advanced care."
Dr. Shapiro said one centre will need to assume responsibility for continuity of care for patients. "For this to actually happen, the academic health science centre might be the one that has to accept the responsibility. But we would need a far more robust communication system travelling with the individual who needs care than we have now."
The second continuity defined by Dr. Shapiro is to provide care from health to illness back to health. "This implies an added responsibility to re-introduce the patient back into society and the workplace once the condition has been adequately treated."
And the third continuity Dr. Shapiro identified is progression through the life cycle. "The range of commitment of the university health care centre to the entire range of care from pediatric to geriatric is not simply a matter of convenience, but stems from an understanding that we cannot otherwise the highest quality of care for community nor generate the critical mass of expertise that such care requires."
Dr. Shapiro said Memorial's Faculty of Medicine has a particular
advantage in adopting this model because it is less isolated from the community than
academic centres in larger centres. His talk was the third in a series of anniversary
lectures celebrating the 30th anniversary of the medical school.
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