- Email: [email protected]
Rebuttal From Drs Foreman, Lopez, and Flenaugh
Accepted Manuscript Rebuttal From Drs Foreman, Lopez, and Flenaugh Marilyn G. Foreman, MD, MS, FCCP, Victoria Lopez, MD, Eric L. Flenaugh, MD, FCCP PII:
S0012-3692(16)60771-7
DOI:
10.1016/j.chest.2016.09.044
Reference:
CHEST 743
To appear in:
CHEST
Received Date: 20 September 2016 Accepted Date: 21 September 2016
Please cite this article as: Foreman MG, Lopez V, Flenaugh EL, Rebuttal From Drs Foreman, Lopez, and Flenaugh, CHEST (2016), doi: 10.1016/j.chest.2016.09.044. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Rebuttal From Drs Foreman, Lopez, and Flenaugh
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Victoria Lopez, MD Department of Medicine Morehouse School of Medicine [email protected]
RI PT
Marilyn G. Foreman, MD, MS, FCCP Pulmonary and Critical Care Medicine Morehouse School of Medicine [email protected]
M AN U
Eric L. Flenaugh, MD, FCCP Pulmonary and Critical Care Medicine Morehouse School of Medicine [email protected]
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Correspondence to: Marilyn G. Foreman, MD, MS, FCCP [email protected]
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EP
Conflict of interest statement: The authors report no personal, financial, intellectual or other conflicts of interest in relationship to this manuscript.
ACCEPTED MANUSCRIPT
We agree with Dr. Freedman’s assessment that disparate pressures have transformed medical practice, where the notion of a traditional private
RI PT
medical practice is now an antiquated option.1 The modern paradigm finds that more physicians are employees rather than independent practitioners, administratively managed to achieve financial and other metrics. Loss of
SC
control, greater job dissatisfaction, economic, bureaucratic, and other pressures on practicing physicians have trickled down to impact the career
M AN U
choices of medical students.2 Medical students consider lifestyle impact, a major criterion, when making ultimate career selections. The motivations that entice physicians to consider practicing concierge medicine have been
TE D
well articulated in the accompanying Point Debate but the effect on patients and public health are largely unknown and not addressed.
EP
Failure of a concierge physician to diagnose a case of lung cancer has been published and is among the case study files of a medical malpractice
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insurance company.3,4 This report is not provided to highlight the shortcomings of concierge medicine but to suggest that greater access obtained by greater resources may not guarantee better outcomes. Whether concierge practices reduce costs and improve outcomes is unproven. Again, we find agreement with Dr. Freedman that insufficient information is available concerning the overall impact of concierge practices and
ACCEPTED MANUSCRIPT
pulmonary medicine.
Informed decisions require objective, unbiased
RI PT
analyses independent of the concierge medicine industry.
Though our current position is to advocate caution in support of concierge
pulmonary care, we do advocate support for innovative methods to improve
SC
global respiratory health and anticipate. We look forward to such outcome
AC C
EP
TE D
M AN U
reports for our patients.
ACCEPTED MANUSCRIPT
1.
Freedman N. Point: Is it time for pulmonary concierge practices? Yes. Chest. 2016, in press.
Hauer KE, Durning SJ, Kernan WN, et al. Factors associated with
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2.
RI PT
References
2008;300(10):1154-1164. 3.
M AN U
medical students' career choices regarding internal medicine. JAMA.
Samaritan G. Concierge medicine: failure to diagnose lung cancer. J Med Assoc Ga. 2010;99(1):30-31.
Cancer.
TE D
Concierge Medicine-No Guarantee against Failure to Diagnose Lung
http://www.magmutual.com/sites/default/files/ConciergeMedicine201
EP
4.pdf. Accessed August 9, 2016, 2016.
AC C
4.
S0012-3692(16)60771-7
DOI:
10.1016/j.chest.2016.09.044
Reference:
CHEST 743
To appear in:
CHEST
Received Date: 20 September 2016 Accepted Date: 21 September 2016
Please cite this article as: Foreman MG, Lopez V, Flenaugh EL, Rebuttal From Drs Foreman, Lopez, and Flenaugh, CHEST (2016), doi: 10.1016/j.chest.2016.09.044. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Rebuttal From Drs Foreman, Lopez, and Flenaugh
SC
Victoria Lopez, MD Department of Medicine Morehouse School of Medicine [email protected]
RI PT
Marilyn G. Foreman, MD, MS, FCCP Pulmonary and Critical Care Medicine Morehouse School of Medicine [email protected]
M AN U
Eric L. Flenaugh, MD, FCCP Pulmonary and Critical Care Medicine Morehouse School of Medicine [email protected]
TE D
Correspondence to: Marilyn G. Foreman, MD, MS, FCCP [email protected]
AC C
EP
Conflict of interest statement: The authors report no personal, financial, intellectual or other conflicts of interest in relationship to this manuscript.
ACCEPTED MANUSCRIPT
We agree with Dr. Freedman’s assessment that disparate pressures have transformed medical practice, where the notion of a traditional private
RI PT
medical practice is now an antiquated option.1 The modern paradigm finds that more physicians are employees rather than independent practitioners, administratively managed to achieve financial and other metrics. Loss of
SC
control, greater job dissatisfaction, economic, bureaucratic, and other pressures on practicing physicians have trickled down to impact the career
M AN U
choices of medical students.2 Medical students consider lifestyle impact, a major criterion, when making ultimate career selections. The motivations that entice physicians to consider practicing concierge medicine have been
TE D
well articulated in the accompanying Point Debate but the effect on patients and public health are largely unknown and not addressed.
EP
Failure of a concierge physician to diagnose a case of lung cancer has been published and is among the case study files of a medical malpractice
AC C
insurance company.3,4 This report is not provided to highlight the shortcomings of concierge medicine but to suggest that greater access obtained by greater resources may not guarantee better outcomes. Whether concierge practices reduce costs and improve outcomes is unproven. Again, we find agreement with Dr. Freedman that insufficient information is available concerning the overall impact of concierge practices and
ACCEPTED MANUSCRIPT
pulmonary medicine.
Informed decisions require objective, unbiased
RI PT
analyses independent of the concierge medicine industry.
Though our current position is to advocate caution in support of concierge
pulmonary care, we do advocate support for innovative methods to improve
SC
global respiratory health and anticipate. We look forward to such outcome
AC C
EP
TE D
M AN U
reports for our patients.
ACCEPTED MANUSCRIPT
1.
Freedman N. Point: Is it time for pulmonary concierge practices? Yes. Chest. 2016, in press.
Hauer KE, Durning SJ, Kernan WN, et al. Factors associated with
SC
2.
RI PT
References
2008;300(10):1154-1164. 3.
M AN U
medical students' career choices regarding internal medicine. JAMA.
Samaritan G. Concierge medicine: failure to diagnose lung cancer. J Med Assoc Ga. 2010;99(1):30-31.
Cancer.
TE D
Concierge Medicine-No Guarantee against Failure to Diagnose Lung
http://www.magmutual.com/sites/default/files/ConciergeMedicine201
EP
4.pdf. Accessed August 9, 2016, 2016.
AC C
4.