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Published on 06/01/1998 All articles from this issue

Stanford doctor says medical treatment out of focus

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By Cecilia Keehan

Special to the Town Crier

In Dr. Halsted Holman's opinion, the people who should be negotiating the health care crisis aren't. He believes the right people to develop a health care policy should be patients and physicians, but as he told the June 2 meeting of The Morning Forum of Los Altos, that coalition has not yet emerged.

The doctor, at the Stanford Medical School since 1960, offered several explanations for the emergence of the health care crisis. There are the problems with financing Medicare and Medicaid, and the growth in numbers of people who are underinsured, uninsured, or lack access to health care, he said.

Holman believes that patients should be more in control of their health care. This is especially important since chronic illness replaced acute illness as the major focus of medical treatment.

Treatment of chronic diseases now take up 70 percent of health care costs, he said. "The emergence of chronic diseases as the focus of medical treatment has become the predominant cause of the health care crisis," he said.

He defined acute diseases as those with known causes and cures, where doctors can make accurate diagnosis and provide known treatment. "During treatment, the patient would be a passive participant in his health care," the doctor said.

In the treatment of chronic disease, Holman said these illnesses do not have a known cause or cure and physicians cannot reliably predict what will happen to the patient. "The traditional rules of acute disease treatment do not apply," he said. "In these cases, patients know more about their illnesses than physicians and must become active participants in their health care. The major problem for the health care system is that it has not transformed itself to deal with this change."

Holman, who favors a single-payer system, believes that the practice of medicine must be re-engineered. He believes that salaried doctors will have more of a financial incentive to do phone and e-mail consultations (usually unpaid services) thereby providing improved health care while reducing costs.

Morning Forum is a members-only lecture series held at the United Methodist Church of Los Altos. To get on a waiting list for membership, write to: Morning Forum, P.O. Box 274, Los Altos 94023-0274.