Sick healthcare system and a doctors approach to it. How can we learn from comparative studies?

By Bijan Sadri MD

Problem solving processes are used in many world activities. Businesses use the process to decide on the ways of gaining more profit. Governments use them to gain more control and power. Doctors also use them to treat patients.

Each may use slightly different approaches to this process.

Being a doctor I want to see if the process of patient management can also help us manage and correct the sick healthcare system in the US.

To put it in a very simple way, approaching a patient starts by asking the patient for the problems that they have. Then we continue by doing a thorough inquiry into previous problems and then examination of the patient and asking for Para clinical tests.

In this process you try to ask questions about every aspect of the patient problems and gather row subjective and objective information about their problem.

Thus far in our study group we have also so far tried to ask what problems there are in our healthcare system and listed them.

The difference between problem solving methods in medicine and other world affairs is that medicine relies heavily on the use of medical literature in every step of the way. Problems have already been described and can be retrieved from databases and previous studies.

In medicine you try to paint a picture of problems that your patient have. And you call them syndromes or diseases. It means a group of symptoms that constitute the illness. Then you compare them to the literature and based on that literature and previous works try to find syndromes and diseases that are similar. Physicians devise strategies for correcting problems based on these definitions and advices of those who have previously studied syndromes.

This is different from the top down approach of problem solving where you treat patient’s pains as small pieces of problems. And also different from the bottom up approach where you find a problem list and group them and devise a new picture and correct that.

It is different in that in each step of the way you go back to the literature and try to find similarities. This will cut your problem solving time greatly and by using comparative problem solving method. It makes your work more efficient. Basically we try to find similar pictures in the literature.

Now the question is how we can use the medical problem solving method in our goal of solving the healthcare system.

We have thus far started by putting together list of problems and are trying to group them together. A doctor’s approach in this step of the way is to look at the literature and find similarities between these problems and issues and the literature.

For national policy making a good approach is also to look at the literature in each step of the way. But what is the nature of that literature? The nature of that literature is the history of the country relevant to that problem and history of other countries and societies for solving those issues and problems.

For our group the best source of information for now with our very limited time and resource is the comparative effectiveness conference held at UCI.

It is best that we come up with our problem list and when we are attending that conference listen carefully and see if other people in other parts of the world had the same problem in their history and how did they deal with those issues.

Though I should emphasis that at the same time that we are open minded we should stay critical of those approaches.

This might help us greatly by providing us with clearer pictures of the problems that we are dealing with and help us with the already tested and safer solutions to those problems.