At 17:34 14/09/06 -0400, Alan Zaslavsky wrote (in part):
>Unfortunately, focusing on volume tends to create a bias toward certain
>kinds of solutions -- such as performing procedures in larger hospitals
>-- that can have deleterious side effects. For example making care less
>available in sparsely populated areas can force people with some
>conditions to travel much further to obtain care, where they are cut off
>from family supports. Thus there can be efficiency-equity tradeoffs, as
>noted in some of the previous postings in this thread. These issues
>deserve much weight in developing the policy implications of volume
>effects.
Indeed so ....
> (The Canadians have even experimented in some areas with having
>highly specialized surgeons perform operations using remote control
>robots to bring the benefits of specialized care to remote areas!)
Yes, and remote _supervision_ of surgery by experts is also under study
(and being used) - not the least, I believe, by the military. Furthermore,
although these discussions often focus on surgeons and surgical skill,
given the capabilities of modern communications there is tremendous scope
for much more general involvement of highly experienced specialists in the
care and management of patients who are widely geographically
dispersed. Such approaches may offer alternative ways forward, combining
the benefits of specialist involvement with the benefits of
locally-administered care - and even offering a route for those climbing
the professional ladder to become 'highly experienced' in some matters
without necessarily laying their hands on vast numbers of patients.
Kind Regards,
John
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