Primary Care Gatekeeping

Found in breach of the duty of care doctors, among other things, failed or diagnosis, treatment failed to warn of hazards, failure to obtain proper consent for treatment, medication errors, the method delay in surgery, and neglected delay in referral to specialists. Where the hospital was negligent in the treatment system can produce errors. Most cases of medical professionals (physicians and surgeons) concerned. But the same principles midwives, nurses, physiotherapists, psychologists and psychiatrists

One of the conflicts that arise in health-care from a conflict perspective is the focus of the provider and is the provider functioning as a scientist or a care giver. Are there objective versus subjective concerns for the patient and is the health care provider treating the disease or is the provider treating the person? The conflict that arises between health-care provider and patient is vastly influenced by the patient’s cultural and social beliefs.

The concept of paternalism involves the notion that one person, generally a person in a position of authority, has the right to intervene and override the autonomy of another person. In terms of historical context, medicine is one area in which paternalism has occurred frequently. Throughout the ages, physicians and doctors have been placed in a position of authority in which they acted upon the bodies of their patients without those patients’ full knowledge or understanding. However, there has been a distinct shift in modern times regarding paternalism. With the publication of The Silent World of Doctor and Patient, Jay Katz advocated for a new attention to be given to the autonomous control of the patient. Katz noted that historically speaking,

A certain services may not also be provided in their area. An example of this could be if a patient lives in Liverpool and have cancer since the best hospital for this is Christie’s hospital in Manchester it would mean that the patient wouldn’t be able to have the same treatments than if they were living in Manchester. At the Christie we accept NHS referrals, Private insurance referrals as well as referrals from Wales, Liverpool, London, Scotland, Ireland, Northern Ireland, Malta, Netherlands, Greece and Spain only to name a few of the places where our patients come from. This is for treatments in Renal Cancer. Therefore some people may not have access to these services (Christie,

The American Medical Association (AMA) published a Code of Ethics for Physicians that includes a list of certain principles physicians should follow in order to be good physicians, practicing in an ethical fashion. This list, which was first adopted in June of 1957 and revised as recently as June of 2001, demonstrates some principles that are not universally accepted to be critical to the ethical practice of a physician. In particular, all physicians do not completely believe the claim that “A physician shall support access to medical care for all people” (Principles of Medical Ethics). Theorist, H. Tristam Engelhardt believes that the lack of access to care for some may be unfortunate, but it is not unfair and that this access does not need to be mandated, nor does believing it should be make you an ethical physician. In fact, Engelhardt supremely believes that by providing access of care to all, you will hurt certain patients that already have access to care, negating your function as a physician practicing beneficence. Engelhardt would retract this statement from the Principles of Ethics. However, this belief of and drive to implement access of care to all is critical to one’s job as a physician and it goes against core values of physicians to claim otherwise. Theorists such as Tom Beauchamp and Norman Daniels would agree that the universal access to health care is a critical component of the values physicians hold.

al., 2011). Health service accessibility by individuals in rural and remote areas is a problem central to both countries. Reports indicate that compared with metropolitan populations, non-metropolitan populations, in both Australia and the UK, experience poor access to health services (Watt, Franks, Sheldon, 1994, p. 16). As in the primary care sector of the UK, majority of the doctors in Australia are self-employed and reimbursed on a fee-for-service approach (Gillies, 2003, p. 77). GP’s are the initial point of contact for patients in both Australia and the UK. Additional specialist medical services such as physiotherapy and optometry are only available when patients are provided with a formal referral from their GPs (Piterman, Koritsas, 2005). Although the NHS is similar to the Australian health system in certain ways, both systems also possess some differences.

Finally, the third alternative to the paternalistic model is the contractual model. This model is similar to paternalism, in that it questions the assumptions of equality, however it differs in that there is a “contract” between both parties, leaving each with their own dignity and moral authority. What is crucial about this model is that it does not neglect the fact that there is an obvious difference in the degree of knowledge between the patient and the physician. Instead of focusing on that discrepancy, the model concentrates on the agreement between the two parties to exchange goods and services and the enforcement of that by government sanctions. In other words, this model compromises between partnership and the reality of medical care, and according to Veatch, is the only realistic way to share all responsibility, while protecting various parties in health care. For example, both parties are freely entering this contract, and therefore are both given the right to leave it, given proper notice. However, while partaking in the contract, there are duties and obligations of each, which may neglect virtues of benevolence, care and compassion, which we do see stressed in other models.

medicine as integrating the dialectic disciplines of primary care and public health in order to

Therefore, medical and government authorities “must act as patient advocates” (Hardicre 486) in healthcare to regain trust. As leaders, they are responsible for maintaining order in society. With trust, the community can work together to solve social differences that arose from the past.

Many physicians in family practice have solo practice settings and receive fees based on services. A study by Hunter et al (2004) showed that many family physicians opposed capitation and patient rosters because many believe that capitation will lead to loss of autonomy. The competition for patients may increase under capitated payment and physicians would move to less serviced areas to attract more patients under their team (Hunter et al., 2004). Another research from Cohen, Ferrier, Woodward, & Brown (2001), found that only five percentage of Ontario family physicians believed that primary care reform will have a positive effect on them. Many family physicians were concerned about changes in practice

Patients seek medical attention for preventative measures, as well as, diagnostic measures. Patients must have a trusting rapport with their collaborative medical team, as the nurses and the doctors are the people who they trust their lives with. Patients do not always present to hospitals, urgent cares, walk-in clinics, or even doctor’s offices only when they are sick; patients visit to ensure their good health will continue, treatment regimens are of benefit, changes that may be needed in regimen. When someone thinks of a patient they may think of some of these characteristics: illness, disease, hospital, medications, health, and prevention.

There are many components that drive, maintain and contribute to the efficiency of healthcare. One major driving force is the Institute of Medicine (IOM), which is an organization that has helped to bridge the numerous gaps between health professionals and patients. The IOM has helped initiate a standard of quality healthcare by setting standards relating to managing the privacy of medical records, control cost and creating a means for nurses to have a voice through continued education by obtaining advanced degrees. However, although IMO has given society the research necessary to guide healthcare decision-making, it has also allowed for government officials to have a strong hold on healthcare decision making which takes away from physician

Gatekeeping is a straightforward and efficient measure to contain costs by reducing the volume of unnecessary interventions. Essentially, the gatekeeper will act as a representative of support for the patient. HMOs focus on preventive care and the implementation of utilization management controls. Primary level healthcare, related tests, and diagnosis are on average less expensive than secondary and specialty care services. GPs are more informative to where and how to seek a specialist, so it ultimately reduces the patient searching for an adequate and a cogitative secondary care provider.

American Hospital Association Patient’s Bill of Rights The evolution of hospitals is the greatest thing that history has to offer. Today, many people depend on hospitals for their health, and they cannot imagine how life would be like without hospitals. The American Hospital Association advocates for the representation of non-profit hospitals in the United States.

Not only do hospitals, doctors, nurses and all other specialists have to play a role in their clients care, clients need to have a responsibility as well. When clients are supplied with correct material, they will require superior support from their doctor and develop into dynamic contributors of one’s wellbeing and medical management. Consumers contain various responsibilities in progressing customer protection by assisting to guarantee one’s personal protection, functioning with healthcare groups to advance security, and promoting as a society for community coverage and responsibility of facilities and health organization achievement.