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December 22/29, 2004

Medical Education and Chronic Disease

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(24):2974-2976. doi:10.1001/jama.292.24.2975-a

To the Editor: The Commentary by Dr Holman1 discusses a gaping hole in the current training and practice of physicians. A related problem which was not addressed is the antiquated payment system and the role it plays in perpetuating this deficiency. That system is built around the acute intervention model and so completely controls the current practice of medicine (particularly primary care) that attempting to change to a rational chronic care model is practically unthinkable in the absence of a radically changed compensation model. It is possible to remake the primary role of the physician in the management of chronic diseases through the use of teams, collaboration with the patient, and full exploitation of current or near-future technology. However, this will not happen unless the payment system is decoupled from the acute-care episode and harnessed instead to measures of appropriate long-term management of medical resources for individual patients.

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