Patients with dementia need social supports and opportunities and acceptance of their disability in order to feel hopeful despite their functional decline.
AMA J Ethics. 2017;19(7):649-655. doi:
10.1001/journalofethics.2017.19.7.ecas2-1707.
Shivan J. Mehta, MD, MBA and David A. Asch, MD, MBA
Outcome-based payment more closely aligns payments with what patients want, which is better health rather than more health care. But these approaches remain challenging to implement.
Measuring outcomes alone is not the answer. There should be a way to reward the doctor for educating a patient about lifestyle modifications and then documenting that the care provided followed patient preferences.
The picture that emerges from study of physician economic behavior is mixed, but from the intensity of responses by some professional societies to Medicare's coding modifier proposal, it appears that economic incentives matter a lot to many of their members.
A judicious approach to autism would be to replace a “disability” or “illness” paradigm with a “diversity” perspective that takes into account both strengths and weaknesses and the idea that variation can be positive in and of itself.
AMA J Ethics. 2015;17(4):348-352. doi:
10.1001/journalofethics.2015.17.4.msoc1-1504.
Viewing dementia as a distinct disease promotes funding for research but may stigmatize those who have dementia and lead to disinvestment in caregiving.
AMA J Ethics. 2017;19(7):713-719. doi:
10.1001/journalofethics.2017.19.7.mhst1-1707.
This process of developing EBM-based guidelines and applying them to clinical care highlights the tension between generating unbiased knowledge based on statistical aggregation and the application of this information to individual patients.