What has changed in health care?

Lately, I’ve been looking back on my career thus far and considering how I may continue to serve patients and the health care industry in the future. Part of this process has included looking over and reorganizing articles I have written over the years, and it appears that we are still confronting issues that I was writing articles about 10 years ago.

In 1998, I wrote an article for Crossroads magazine called "The Courage to Change" about how physicians must transform their behavior so they could begin to think in terms of populations or preventions by becoming schooled in the economics of health care delivery, beginning to talk openly about outcomes with other physicians, accept input from patients and share clinical responsibilities with non-physicians. I made the case for change toward population-based medicine and care management strategies that view patients, disease and health through a wide-angle lens.

One could argue that health care reform aimed to end a compartmentalized approach to health care and align incentives so that providers are rewarded for providing better outcomes instead of more care. While I spoke of the necessity of these things in 1998, it is clear that improvement in this area is still a necessity today.

And while we as physicians and caregivers have come a long way in recognizing and adhering to practice guidelines, clinical pathways, practice profiles and outcome comparisons to generate evidenced-based improved clinical results, our work is far from over. We must continue to challenge ourselves—and one another—to measure up to the higher standards for outcomes, service and resource utilization that we know are possible.